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Bortz CA, Pierce KE, Krol O, Kummer N, Passfall L, Egers M, Oh C, Horn SR, Segreto FA, Vasquez-Montes D, Frangella NJ, Buza JA, Raman T, Kuprys T, Lafage R, Jankowski PP, Hassanzadeh H, Vira SN, Diebo BG, Gerling MC, Passias PG. Predictors of Complication Severity Following Adult Spinal Deformity Surgery: Smoking Rate, Diabetes, and Osteotomy Increase Risk of Severe Adverse Events. Int J Spine Surg 2023; 17:103-111. [PMID: 36750312 PMCID: PMC10025845 DOI: 10.14444/8393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Given the physical and economic burden of complications in spine surgery, reducing the prevalence of perioperative adverse events is a primary concern of both patients and health care professionals. This study aims to identify specific perioperative factors predictive of developing varying grades of postoperative complications in adult spinal deformity (ASD) patients, as assessed by the Clavien-Dindo complication classification (Cc) system. METHODS Surgical ASD patients ≥18 years were identified in the American College of Surgeons' National Surgical Quality Improvement Program from 2005 to 2015. Postoperative complications were stratified by Cc grade severity: minor (I, II, and III) and severe (IV and V). Stepwise regression models generated dataset-specific predictive models for Cc groups. Model internal validation was achieved by bootstrapping and calculating the area under the curve (AUC) of the model. Significance was set at P < 0.05. RESULTS Included were 3936 patients (59 ± 16 years, 63% women, 29 ± 7 kg/m2) undergoing surgery for ASD (4.4 ± 4.7 levels, 71% posterior approach, 11% anterior, and 18% combined). Overall, 1% of cases were revisions, 39% of procedures involved decompression, 27% osteotomy, and 15% iliac fixation. Additionally, 66% of patients experienced at least 1 complication, 0% of which were Cc grade I, 51% II, 5% III, 43% IV, and 1% V. The final model predicting severe Cc (IV-V) complications yielded an AUC of 75.6% and included male sex, diabetes, increased operative time, central nervous system tumor, osteotomy, cigarette pack-years, anterior decompression, and anterior lumbar interbody fusion. Final models predicting specific Cc grades were created. CONCLUSIONS Specific predictors of adverse events following ASD-corrective surgery varied for complications of different severities. Multivariate modeling showed smoking rate, osteotomy, diabetes, anterior lumbar interbody fusion, and higher operative time, among other factors, as predictive of severe complications, as classified by the Clavien-Dindo Cc system. These factors can help in the identification of high-risk patients and, consequently, improve preoperative patient counseling. CLINICAL RELEVANCE The findings of this study provide a foundation for identifying ASD patients at high risk of postoperative complications . LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Cole A Bortz
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Oscar Krol
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Nicholas Kummer
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Lara Passfall
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Max Egers
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Cheongeun Oh
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Samantha R Horn
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Frank A Segreto
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Nicholas J Frangella
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - John A Buza
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Tina Raman
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Tomas Kuprys
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Pawel P Jankowski
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA
| | - Shaleen N Vira
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Michael C Gerling
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
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Passias PG, Fernandez L, Horn SR, Ihejirika YU, Wang E, Vasques-Montes D, Shepard N, Segreto FA, Bortz CA, Brown AE, Pierce KE, Alas H, Lafage R, Neuman BJ, Sciubba DM, Afthinos J, Lafage V, Schoenfeld AJ. Bariatric Surgery Lowers Rates of Spinal Symptoms and Spinal Surgery in a Morbidly Obese Population. Clin Spine Surg 2022; 35:371-375. [PMID: 35550396 DOI: 10.1097/bsd.0000000000001346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 03/01/2022] [Indexed: 01/25/2023]
Abstract
STUDY DESIGN Retrospective analysis of New York State Inpatient Database years 2004-2013. OBJECTIVE Assess rates of spinal diagnoses and procedures before and after bariatric surgery (BS). SUMMARY OF BACKGROUND DATA BS for morbid obesity helps address common comorbidity burdens and improves quality of life for patients. The effects of BS on spinal disorders and surgical intervention have yet to be investigated. MATERIALS AND METHODS Patients included in analysis if they underwent BS and were seen at the hospital before and after this intervention. Spinal conditions and rates of surgery assessed before and after BS using χ 2 tests for categorical variables. Multivariable logistic regression analysis used to compare rates in BS patients to control group of nonoperative morbidly obese patients. Logistic testing controlled for comorbidities, age, biological sex. RESULTS A total of 73,046 BS patients included (age 67.88±17.66 y, 56.1% female). For regression analysis, 299,504 nonbariatric, morbidly obese patients included (age 53.45±16.52 y, 65.6% female). Overall, rates of spinal symptoms decreased following BS (7.40%-5.14%, P <0.001). Cervical, thoracic, lumbar spine diagnoses rates dropped from 3.28% to 2.99%, 2.91% to 2.57%, and 5.39% to 3.92% (all P <0.001), respectively. Most marked reductions seen in cervical spontaneous compression fractures, cervical disc herniation, thoracic radicular pain, spontaneous lumbar compression fractures, lumbar spinal stenosis, lumbar spondylosis. Controlling for comorbidities, age and sex, obese nonbariatric patients more likely to have encounters associated with several cervical, thoracic or lumbar spinal diagnoses and procedures, especially for cervical spontaneous compression fracture, radicular pain, lumbar spondylosis, lumbar spinal stenosis, posterior procedures. BS significantly lowered comorbidity burden for many specific factors. CONCLUSIONS BS lowered rates of documented spinal disorders and procedures in a morbidly obese population. These findings provide evidence of additional health benefits following BS, including reduction in health care encounters for spinal disorders and rates of surgical intervention.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Laviel Fernandez
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Yael U Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Erik Wang
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | | | - Nicholas Shepard
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Frank A Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Avery E Brown
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | | | - Haddy Alas
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Manhattan, NY
| | - Brian J Neuman
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - Daniel M Sciubba
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, MD
| | - John Afthinos
- Department of General Surgery, Northwell Health Long Island Jewish Medical Center, Queens, NY
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Manhattan, NY
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Passias PG, Segreto FA, Imbo B, Williamson T, Joujon-Roche R, Tretiakov P, Krol O, Naessig S, Bortz CA, Horn SR, Ahmad W, Pierce K, Ihejirika YU, Lafage V. Defining age-adjusted spinopelvic alignment thresholds: should we integrate BMI? Spine Deform 2022; 10:1077-1084. [PMID: 35657561 DOI: 10.1007/s43390-022-00522-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To develop age- and BMI-adjusted alignment targets to improve patient-specific management and operative treatment outcomes. METHODS Retrospective review of a single-center stereographic database. ASD patients receiving operative or non-operative treatment, ≥ 18y/o with complete baseline (BL) ODI scores and radiographic parameters (PT, SVA, PILL, TPA) were included. Patients were stratified by age consistent with US-Normative values (norms) of SF-36(< 35, 35-55, 45-54, 55-64, 65-74, ≥ 75y/o), and dichotomized by BMI (Non-Obese < 30; Obese ≥ 30). Linear regression analysis established normative age- and BMI-specific radiographic thresholds, utilizing previously published age-specific US-Normative ODI values converted from SF-36 PCS (Lafage et al.), in conjunction with BL age and BMI means. RESULTS 486 patients were included (Age: 52.5, Gender: 68.7%F, mean BMI: 26.2, mean ODI: 32.7), 135 of which were obese. Linear regression analysis developed age- and BMI-specific alignment thresholds, indicating PT, SVA, PILL, and TPA to increase with both increased age and increased BMI (all R > 0.5, p < 0.001). For non-obese patients, PT, SVA, PILL, and TPA ranged from 10.0, - 25.8, - 9.0, 3.1 in patients < 35y/o to 27.8, 53.4, 17.7, 25.8 in patients ≥ 75 y/o. Obese patients' PT, SVA, PILL, and TPA ranged from 10.5, - 7.6, - 7.1, 5.8 in patients < 35 y/o to 28.3, 67.0, 19.15, 27.7 in patients ≥ 75y/o. Normative SVA values in obese patients were consistently ≥ 10 mm greater compared to non-obese values, at all ages. CONCLUSION Significant associations exist between age, BMI, and sagittal alignment. While BMI influenced age-adjusted alignment norms for PT, SVA, PILL, and TPA at all ages, obesity most greatly influenced SVA, with normative values similar to non-obese patients who were 10 years older. Age-adjusted alignment thresholds should take BMI into account, calling for less rigorous alignment objectives in older and obese patients.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA. .,Division of Spinal Surgery, Department of Orthopaedic and Neurological Surgery, NYU School of Medicine, New York Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
| | - Frank A Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Bailey Imbo
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Tyler Williamson
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Rachel Joujon-Roche
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Peter Tretiakov
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Oscar Krol
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Sara Naessig
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Waleed Ahmad
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Katherine Pierce
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Yael U Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | - Virginie Lafage
- Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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Passias PG, Pierce KE, Horn SR, Segar A, Passfall L, Kummer N, Krol O, Bortz C, Brown AE, Alas H, Segreto FA, Ahmad W, Naessig S, Buckland AJ, Protopsaltis TS, Gerling M, Lafage R, Schwab FJ, Lafage V. Cervical Deformity Correction Fails to Achieve Age-Adjusted Spinopelvic Alignment Targets. Int J Spine Surg 2022; 16:450-457. [PMID: 35772976 DOI: 10.14444/8260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess whether surgical cervical deformity (CD) patients meet spinopelvic age-adjusted alignment targets, reciprocal, and lower limb compensation changes. STUDY DESIGN Retrospective review. METHODS CD was defined as C2-C7 lordosis >10°, cervical sagittal vertical angle (cSVA) >4 cm, or T1 slope minus cervical lordosis (TS-CL) >20°. Inclusion criteria were age >18 years and undergoing surgical correction with complete baseline and postoperative imaging. Published formulas were used to create age-adjusted alignment target for pelvic tilt (PT), pelvic incidence and lumbar lordosis (PI-LL), sagittal vertical angle (SVA), and lumbar lordosis and thoracic kyphosis (LL-TK). Actual alignment was compared with age-adjusted ideal values. Patients who matched ±10-year thresholds for age-adjusted targets were compared with unmatched cases (under- or overcorrected). RESULTS A total of 120 CD patients were included (mean age, 55.1 years; 48.4% women; body mass index, 28.8 kg/m2). For PT, only 24.4% of patients matched age-adjusted alignment, 51.1% overcorrected for PT, and 24.4% undercorrected. For PI-LL, only 27.6% of CD patients matched age-adjusted targets, with 49.4% overcorrected and 23% undercorrected postoperatively. Forty percent of patients matched age-adjusted target for SVA, 41.3% overcorrected, and 18.8% undercorrected. CD patients who had worsened in TS-CL or cSVA postoperatively displayed increased TK (-41.1° to -45.3°, P = 1.06). With lower extremity compensation, CD patients decreased in ankle flexion angle postoperatively (6.1°-5.5°, P = 0.036) and trended toward smaller sacrofemoral angle (199.6-195.6 mm, P = 0.286) and knee flexion (2.6° to -1.1°, P = 0.269). CONCLUSIONS In response to worsening CD postoperatively, patients increased in TK and recruited less lower limb compensation. Almost 75% of CD patients did not meet previously established spinopelvic alignment goals, of whom a subset of patients were actually made worse off in these parameters following surgery. This finding raises the question of whether we should be looking at the entire spine when treating CD. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Peter G Passias
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Samantha R Horn
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Anand Segar
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Lara Passfall
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Nicholas Kummer
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Oscar Krol
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Cole Bortz
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Avery E Brown
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Haddy Alas
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Frank A Segreto
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Waleed Ahmad
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Sara Naessig
- Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
| | - Aaron J Buckland
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | - Michael Gerling
- Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Passias PG, Poorman GW, Vasquez-Montes D, Kummer N, Mundis G, Anand N, Horn SR, Segreto FA, Passfall L, Krol O, Diebo B, Burton D, Buckland A, Gerling M, Soroceanu A, Eastlack R, Kojo Hamilton D, Hart R, Schwab F, Lafage V, Shaffrey C, Sciubba D, Bess S, Ames C, Klineberg E. Predictive Analytics for Determining Extended Operative Time in Corrective Adult Spinal Deformity Surgery. Int J Spine Surg 2022; 16:291-299. [PMID: 35444038 PMCID: PMC9930651 DOI: 10.14444/8174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND More sophisticated surgical techniques for correcting adult spinal deformity (ASD) have increased operative times, adding to physiologic stress on patients and increased complication incidence. This study aims to determine factors associated with operative time using a statistical learning algorithm. METHODS Retrospective review of a prospective multicenter database containing 837 patients undergoing long spinal fusions for ASD. Conditional inference decision trees identified factors associated with skin-to-skin operative time and cutoff points at which factors have a global effect. A conditional variable-importance table was constructed based on a nonreplacement sampling set of 2000 conditional inference trees. Means comparison for the top 15 variables at their respective significant cutoffs indicated effect sizes. RESULTS Included: 544 surgical ASD patients (mean age: 58.0 years; fusion length 11.3 levels; operative time: 378 minutes). The strongest predictor for operative time was institution/surgeon. Center/surgeons, grouped by decision tree hierarchy, a and b were, on average, 2 hours faster than center/surgeons c-f, who were 43 minutes faster than centers g-j, all P < 0.001. The next most important predictors were, in order, approach (combined vs posterior increases time by 139 minutes, P < 0.001), levels fused (<4 vs 5-9 increased time by 68 minutes, P < 0.050; 5-9 vs < 10 increased time by 47 minutes, P < 0.001), age (age <50 years increases time by 57 minutes, P < 0.001), and patient frailty (score <1.54 increases time by 65 minutes, P < 0.001). Surgical techniques, such as three-column osteotomies (35 minutes), interbody device (45 minutes), and decompression (48 minutes), also increased operative time. Both minor and major complications correlated with <66 minutes of increased operative time. Increased operative time also correlated with increased hospital length of stay (LOS), increased estimated intraoperative blood loss (EBL), and inferior 2-year Oswestry Disability Index (ODI) scores. CONCLUSIONS Procedure location and specific surgeon are the most important factors determining operative time, accounting for operative time increases <2 hours. Surgical approach and number of levels fused were also associated with longer operative times, respectively. Extended operative time correlated with longer LOS, higher EBL, and inferior 2-y ODI outcomes. CLINICAL RELEVANCE We further identified the poor outcomes associated with extended operative time during surgical correction of ASD, and attributed the useful predictors of time spent in the operating room, including site, surgeon, surgical approach, and the number of levels fused. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Peter G. Passias
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Gregory W. Poorman
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Dennis Vasquez-Montes
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Nicholas Kummer
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Gregory Mundis
- Department of Orthopaedics, San Diego Center for Spinal Disorders, La Jolla, CA, USA
| | - Neel Anand
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Samantha R. Horn
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Frank A. Segreto
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Lara Passfall
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Oscar Krol
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Bassel Diebo
- Department of Orthopaedics, SUNY Downstate Medical Center, New York, NY, USA
| | - Doug Burton
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Aaron Buckland
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Michael Gerling
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Alex Soroceanu
- Department of Orthopaedics, University of Calgary, Calgary, AB, Canada
| | - Robert Eastlack
- Department of Orthopaedics, San Diego Center for Spinal Disorders, La Jolla, CA, USA
| | - D. Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert Hart
- Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank Schwab
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | | | - Daniel Sciubba
- Department of Neurologic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
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Agha A, Wang X, Wang M, Lehrer EJ, Horn SR, Rosenberg JC, Trifiletti DM, Diaz R, Louie AV, Zaorsky NG. Long-Term Risk of Death From Heart Disease Among Breast Cancer Patients. Front Cardiovasc Med 2022; 9:784409. [PMID: 35498020 PMCID: PMC9043135 DOI: 10.3389/fcvm.2022.784409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Most breast cancer patients die of non-cancer causes. The risk of death from heart disease, a leading cause of death, is unknown. The aim of this study is to characterize the long-term risk of fatal heart disease in breast cancer patients. Methods This retrospective study used the Surveillance, Epidemiology, and End Results (SEER) database. Standard mortality ratios (SMR) were calculated for breast cancer patients diagnosed from 1992 to 2014. Patients were stratified by receipt of radiotherapy and/or chemotherapy, disease laterality, and diagnosis era. Hazard ratios (HRs) and odds ratios (ORs) were calculated to compare the risk of death from heart disease among other breast cancer patients. Results There were 1,059,048 patients diagnosed with breast cancer from 1992 to 2014, of which 47,872 (4.6%) died from heart disease. The SMR for death from heart disease at 10+ years for patients who received only radiotherapy was 2.92 (95% CI 2.81–3.04, p < 0.001) and in patients who received only chemotherapy was 5.05 (95% CI 4.57–5.55, p < 0.001). There was no statistically significant difference in SMR for death from heart disease for left-sided vs. right-sided disease. At 10+ years, heart disease made up 28% of deaths from non-primary cancer. HRs and ORs showed that the risk of death from heart disease was highest in patients older than 70 years of age and with longer follow-up. Conclusion The risk of fatal heart disease was highest in older breast cancer patients with longer follow-up (i.e., >5–10 years) and who received chemotherapy. These patients should be referred to cardio-oncology clinics to mitigate this risk.
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Affiliation(s)
- Aya Agha
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States
| | - Xi Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Ming Wang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Eric J. Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samantha R. Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States
| | - Jennifer C. Rosenberg
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States
| | | | - Roberto Diaz
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, United States
| | - Alexander V. Louie
- Department of Radiation Oncology, Odette Cancer Centre – Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicholas G. Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, United States
- *Correspondence: Nicholas G. Zaorsky,
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Passias PG, Passfall L, Horn SR, Pierce KE, Lafage V, Lafage R, Smith JS, Line BG, Mundis GM, Eastlack R, Diebo BG, Protopsaltis TS, Kim HJ, Scheer J, Burton DC, Hart RA, Schwab FJ, Bess S, Ames CP, Shaffrey CI. Risk-benefit assessment of major versus minor osteotomies for flexible and rigid cervical deformity correction. J Craniovertebr Junction Spine 2021; 12:263-268. [PMID: 34728993 PMCID: PMC8501816 DOI: 10.4103/jcvjs.jcvjs_35_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Osteotomies are commonly performed to correct sagittal malalignment in cervical deformity (CD). However, the risks and benefits of performing a major osteotomy for cervical deformity correction have been understudied. The objective of this retrospective cohort study was to investigate the risks and benefits of performing a major osteotomy for CD correction. Methods: Patients stratified based on major osteotomy (MAJ) or minor (MIN). Independent t-tests and Chi-squared tests were used to assess differences between MAJ and MIN. A sub-analysis compared patients with flexible versus rigid CL. Results: 137 CD patients were included (62 years, 65% F). 19.0% CD patients underwent a MAJ osteotomy. After propensity score matching for cSVA, 52 patients were included. About 19.0% CD patients underwent a MAJ osteotomy. MAJ patients had more minor complications (P = 0.045), despite similar surgical outcomes as MIN. At 3M, MAJ and MIN patients had similar NDI, mJOA, and EQ5D scores, however by 1 year, MAJ patients reached MCID for NDI less than MIN patients (P = 0.003). MAJ patients with rigid deformities had higher rates of complications (79% vs. 29%, P = 0.056) and were less likely to show improvement in NDI at 1 year (0.95 vs. 0.54, P = 0.027). Both groups had similar sagittal realignment at 1 year (all P > 0.05). Conclusions: Cervical deformity patients who underwent a major osteotomy had similar clinical outcomes at 3-months but worse outcomes at 1-year as compared to minor osteotomies, likely due to differences in baseline deformity. Patients with rigid deformities who underwent a major osteotomy had higher complication rates and worse clinical improvement despite similar realignment at 1 year.
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Affiliation(s)
- Peter Gust Passias
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Lara Passfall
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Samantha R Horn
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton G Line
- Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's, Rocky Mountain Hospital for Children, Denver, CO, USA
| | | | - Robert Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, USA
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate, New York, NY, USA
| | | | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's, Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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8
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Passias PG, Horn SR, Oh C, Poorman GW, Bortz C, Segreto F, Lafage R, Diebo B, Scheer JK, Smith JS, Shaffrey CI, Eastlack R, Sciubba DM, Protopsaltis T, Kim HJ, Hart RA, Lafage V, Ames CP. Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity. J Craniovertebr Junction Spine 2021; 12:228-235. [PMID: 34728988 PMCID: PMC8501815 DOI: 10.4103/jcvjs.jcvjs_40_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/28/2021] [Indexed: 11/04/2022] Open
Abstract
Background For cervical deformity (CD) surgery, goals include realignment, improved patient quality of life, and improved clinical outcomes. There is limited research identifying patients most likely to achieve all three. Objective The objective is to create a model predicting good 1-year postoperative realignment, quality of life, and clinical outcomes following CD surgery using baseline demographic, clinical, and radiographic factors. Methods Retrospective review of a multicenter CD database. CD patients were defined as having one of the following radiographic criteria: Cervical sagittal vertical axis (cSVA) >4 cm, cervical kyphosis/scoliosis >10°° or chin-brow vertical angle >25°. The outcome assessed was whether a patient achieved both a good radiographic and clinical outcome. The primary analysis was stepwise regression models which generated a dataset-specific prediction model for achieving a good radiographic and clinical outcome. Model internal validation was achieved by bootstrapping and calculating the area under the curve (AUC) of the final model with 95% confidence intervals. Results Seventy-three CD patients were included (61.8 years, 58.9% F). The final model predicting the achievement of a good overall outcome (radiographic and clinical) yielded an AUC of 73.5% and included the following baseline demographic, clinical, and radiographic factors: mild-moderate myelopathy (Modified Japanese Orthopedic Association >12), no pedicle subtraction osteotomy, no prior cervical spine surgery, posterior lowest instrumented vertebra (LIV) at T1 or above, thoracic kyphosis >33°°, T1 slope <16 and cSVA <20 mm. Conclusions Achievement of a positive outcome in radiographic and clinical outcomes following surgical correction of CD can be predicted with high accuracy using a combination of demographic, clinical, radiographic, and surgical factors, with the top factors being baseline cSVA <20 mm, no prior cervical surgery, and posterior LIV at T1 or above.
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Affiliation(s)
- Peter Gust Passias
- Department of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center, New York Spine Institute, New York, USA
| | - Samantha R Horn
- Department of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center, New York Spine Institute, New York, USA
| | - Cheongeun Oh
- Department of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center, New York Spine Institute, New York, USA
| | - Gregory W Poorman
- Department of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center, New York Spine Institute, New York, USA
| | - Cole Bortz
- Department of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center, New York Spine Institute, New York, USA
| | - Frank Segreto
- Department of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center, New York Spine Institute, New York, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | | | - Robert Eastlack
- Department of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, MD, USA
| | - Themistocles Protopsaltis
- Department of Orthopaedic and Neurologic Surgery, NYU Langone Medical Center, New York Spine Institute, New York, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Medical Center, Seattle, WA, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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Chen H, Stoltzfus KC, Lehrer EJ, Horn SR, Siva S, Trifiletti DM, Meng MB, Verma V, Louie AV, Zaorsky NG. The Epidemiology of Lung Metastases. Front Med (Lausanne) 2021; 8:723396. [PMID: 34616754 PMCID: PMC8488106 DOI: 10.3389/fmed.2021.723396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/11/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction: Lung metastasis is usually associated with poor outcomes in cancer patients. This study was performed to characterize and analyze the population of patients with de novo (synchronous) lung metastases using the Surveillance, Epidemiology and End Results (SEER) database. Materials and Methods: Baseline characteristics of lung metastasis patients were obtained from SEER case listings. Incidence rates and counts of synchronous lung metastasis were also obtained using the SEER*Stat software. Survival outcomes were analyzed using univariate and multivariable Cox regressions, controlling for confounders. An alpha threshold of 0.05 was used for statistical significance and p-values were subject to correction for multiple comparisons. Results: The age-adjusted incidence rate of synchronous lung metastasis was 17.92 per 100,000 between 2010 and 2015. Synchronous lung metastases most commonly arose from primary lung cancers, colorectal cancers, kidney cancers, pancreatic cancers and breast cancers. During this time period, 4% of all cancer cases presented with synchronous lung metastasis. The percentage of patients presenting with synchronous lung metastasis ranged from 0.5% of all prostate cancers to 13% of all primary lung cancers. The percentage of all cancer cases presenting with synchronous lung metastasis increased over time. De novo metastatic patients with lung metastases had worse overall survival [hazard ratio = 1.22 (1.21–1.23), p < 0.001] compared to those with only extrapulmonary metastases, controlling for potential confounders. Conclusions: Synchronous lung metastasis occurs frequently and is an independent predictors of poor patient outcomes. As treatment for lung metastases becomes more complicated, patients with synchronous lung metastasis represent a high-risk population.
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Affiliation(s)
- Hanbo Chen
- Department of Radiation Oncology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Kelsey C Stoltzfus
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States.,Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Samantha R Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States.,Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Daniel M Trifiletti
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, United States
| | - Mao-Bin Meng
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, United States
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, United States.,Department of Public Health Sciences, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
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10
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Segreto FA, Passias PG, Brown AE, Horn SR, Bortz CA, Pierce KE, Alas H, Lafage V, Lafage R, Smith JS, Line BG, Diebo BG, Kelly MP, Mundis GM, Protopsaltis TS, Soroceanu A, Kim HJ, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. The Influence of Surgical Intervention and Sagittal Alignment on Frailty in Adult Cervical Deformity. Oper Neurosurg (Hagerstown) 2021; 18:583-589. [PMID: 31701155 DOI: 10.1093/ons/opz331] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 08/29/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Frailty is a relatively new area of study for patients with cervical deformity (CD). As of yet, little is known of how operative intervention influences frailty status for patients with CD. OBJECTIVE To investigate drivers of postoperative frailty score and variables within the cervical deformity frailty index (CD-FI) algorithm that have the greatest capacity for change following surgery. METHODS Descriptive analysis of the cohort were performed, paired t-tests determined significant baseline to 1 yr improvements of factors comprising the CD-FI. Pearson bivariate correlations identified significant associations between postoperative changes in overall CD-FI score and CD-FI score components. Linear regression models determined the effect of successful surgical intervention on change in frailty score. RESULTS A total of 138 patients were included with baseline frailty scores of 0.44. Following surgery, mean 1-yr frailty score was 0.27. Of the CD-FI variables, 13/40 (32.5%) were able to improve with surgery. Frailty improvement was found to significantly correlate with baseline to 1-yr change in CBV, PI-LL, PT, and SVA C7-S1. HRQL CD-FI components reading, feeling tired, feeling exhausted, and driving were the greatest drivers of change in frailty. Linear regression analysis determined successful surgical intervention and feeling exhausted to be the greatest significant predictors of postoperative change in overall frailty score. CONCLUSION Complications, correction of sagittal alignment, and improving a patient's ability to read, drive, and chronic exhaustion can significantly influence postoperative frailty. This analysis is a step towards a greater understanding of the relationship between disability, frailty, and surgery in CD.
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Affiliation(s)
- Frank A Segreto
- Division of Spine Surgery, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York University, New York, New York.,Department of Neurosurgery, NYU Hospital for Joint Diseases, New York University, New York, New York
| | - Peter Gust Passias
- Division of Spine Surgery, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York University, New York, New York.,Department of Neurosurgery, NYU Hospital for Joint Diseases, New York University, New York, New York
| | - Avery E Brown
- Division of Spine Surgery, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York University, New York, New York.,Department of Neurosurgery, NYU Hospital for Joint Diseases, New York University, New York, New York
| | - Samantha R Horn
- Division of Spine Surgery, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York University, New York, New York.,Department of Neurosurgery, NYU Hospital for Joint Diseases, New York University, New York, New York
| | - Cole A Bortz
- Division of Spine Surgery, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York University, New York, New York.,Department of Neurosurgery, NYU Hospital for Joint Diseases, New York University, New York, New York
| | - Katherine E Pierce
- Division of Spine Surgery, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York University, New York, New York.,Department of Neurosurgery, NYU Hospital for Joint Diseases, New York University, New York, New York
| | - Haddy Alas
- Division of Spine Surgery, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York University, New York, New York.,Department of Neurosurgery, NYU Hospital for Joint Diseases, New York University, New York, New York
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, University of Virginia, Charlottesville, Virginia
| | - Breton G Line
- Department of Orthopedic Surgery, Rocky Mountain Scoliosis and Spine Center, Denver, Colorado
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate Health Sciences University, New York, New York
| | - Michael P Kelly
- Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
| | | | - Themistocles S Protopsaltis
- Division of Spine Surgery, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York University, New York, New York.,Department of Neurosurgery, NYU Hospital for Joint Diseases, New York University, New York, New York
| | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Canada
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, California
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, University of Kansas, Kansas City, Kansas
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Frank J Schwab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, Colorado
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, University of Virginia, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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11
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Horn SR, Passias PG, Passfall L, Lafage R, Smith JS, Poorman GW, Steinmetz LM, Bortz CA, Segreto FA, Diebo B, Hart R, Burton D, Shaffrey CI, Sciubba DM, Klineberg EO, Protopsaltis TS, Schwab FJ, Bess S, Lafage V, Ames C. Improvement in some Ames-ISSG cervical deformity classification modifier grades may correlate with clinical improvement. J Clin Neurosci 2021; 89:297-304. [PMID: 34119284 DOI: 10.1016/j.jocn.2021.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022]
Abstract
This retrospective cohort study describes adult cervical deformity(ACD) patients with Ames-ACD classification at baseline(BL) and 1-year post-operatively and assesses the relationship of improvement in Ames modifiers with clinical outcomes. Patients ≥ 18yrs with BL and post-op(1-year) radiographs were included. Patients were categorized with Ames classification by primary deformity descriptors (C = cervical; CT = cervicothoracic junction; T = thoracic; S = coronal) and alignment/myelopathy modifiers(C2-C7 Sagittal Vertical Axis[cSVA], T1 Slope-Cervical Lordosis[TS-CL], Horizontal Gaze[Horiz], mJOA). Univariate analysis evaluated demographics, clinical intervention, and Ames deformity descriptor. Patients were evaluated for radiographic improvement by Ames classification and reaching Minimal Clinically Important Differences(MCID) for mJOA, Neck Disability Index(NDI), and EuroQuol-5D(EQ5D). A total of 73 patients were categorized: C = 41(56.2%), CT = 18(24.7%), T = 9(12.3%), S = 5(6.8%). By Ames modifier 1-year improvement, 13(17.8%) improved in mJOA, 26(35.6%) in cSVA grade, 19(26.0%) in Horiz, and 15(20.5%) in TS-CL. The overall proportion of patients without severe Ames modifier grades at 1-year was as follows: 100% cSVA, 27.4% TS-CL, 67.1% Horiz, 69.9% mJOA. 1-year post-operatively, severe myelopathy(mJOA = 3) prevalence differed between Ames-ACD descriptors (C = 26.3%, CT = 15.4%, T = 0.0%, S = 0.0%, p = 0.033). Improvement in mJOA modifier correlated with reaching 1-year NDI MCID in the overall cohort (r = 0.354,p = 0.002). For C descriptors, cSVA improvement correlated with reaching 1-year NDI MCID (r = 0.387,p = 0.016). Improvement in more than one radiographic Ames modifier correlated with reaching 1-year mJOA MCID (r = 0.344,p = 0.003) and with reaching more than one MCID for mJOA, NDI, and EQ-5D (r = 0.272,p = 0.020). In conclusion, improvements in radiographic Ames modifier grades correlated with improvement in 1-year postoperative clinical outcomes. Although limited in scope, this analysis suggests the Ames-ACD classification may describe cervical deformity patients' alignment and outcomes at 1-year.
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Affiliation(s)
- Samantha R Horn
- Department of Orthopaedics, NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA
| | - Peter G Passias
- Department of Orthopaedics, NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA.
| | - Lara Passfall
- Department of Orthopaedics, NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Gregory W Poorman
- Department of Orthopaedics, NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA
| | - Leah M Steinmetz
- Department of Orthopaedics, NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedics, NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA
| | - Frank A Segreto
- Department of Orthopaedics, NYU Medical Center-Hospital for Joint Diseases, New York, NY, USA
| | - Bassel Diebo
- Department of Orthopaedics, SUNY Downstate Medical Center, New York, NY, USA
| | - Robert Hart
- Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Douglas Burton
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Daniel M Sciubba
- Department of Neurologic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | | | - Frank J Schwab
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Virginie Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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12
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Passias PG, Bortz CA, Lafage V, Lafage R, Smith JS, Line B, Eastlack R, Gupta MC, Hostin RA, Horn SR, Segreto FA, Egers M, Sciubba DM, Gum JL, Kebaish KM, Klineberg EO, Burton DC, Schwab FJ, Shaffrey CI, Ames CP, Bess S. Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis. Oper Neurosurg (Hagerstown) 2021; 18:118-125. [PMID: 31149719 DOI: 10.1093/ons/opz093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 01/13/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite reports showing positive long-term functional outcomes following adult spinal deformity (ASD)-corrective surgery, it is unclear which factors affect the durability of these outcomes. OBJECTIVE To assess durability of functional gains following ASD-corrective surgery; determine predictors for postoperative loss of functionality. METHODS Surgical ASD patients > 18 yr with 3-yr Oswestry Disability Index (ODI) follow-up, and 1-yr postoperative (1Y) ODI scores reaching substantial clinical benefit (SCB) threshold (SCB < 31.3 points). Patients were grouped: those sustaining ODI at SCB threshold beyond 1Y (sustained functionality) and those not (functional decline). Kaplan-Meier survival analysis determined postoperative durability of functionality. Multivariate Cox regression assessed the relationship between patient/surgical factors and functional decline, accounting for age, sex, and levels fused. RESULTS All 166 included patients showed baseline to 1Y functional improvement (mean ODI: 35.3 ± 16.5-13.6 ± 9.2, P < .001). Durability of satisfactory functional outcomes following the 1Y postoperative interval was 88.6% at 2-yr postoperative, and 71.1% at 3-yr postoperative (3Y). Those sustaining functionality after 1Y had lower baseline C2-S1 sagittal vertical axis (SVA) and T1 slope (both P < .05), and lower 1Y thoracic kyphosis (P = .035). From 1Y to 3Y, patients who sustained functionality showed smaller changes in alignment: pelvic incidence minus lumbar lordosis, SVA, T1 slope minus cervical lordosis, and C2-C7 SVA (all P < .05). Those sustaining functionality beyond 1Y were also younger, less frail at 1Y, and had lower rates of baseline osteoporosis, hypertension, and lung disease (all P < .05). Lung disease (Hazard Ratio:4.8 [1.4-16.4]), 1Y frailty (HR:1.4 [1.1-1.9]), and posterior approach (HR:2.6 [1.2-5.8]) were associated with more rapid decline. CONCLUSION Seventy-one percent of ASD patients maintained satisfactory functional outcomes by 3Y. Of those who failed to sustain functionality, the largest functional decline occurred 3-yr postoperatively. Frailty, preoperative comorbidities, and surgical approach affected durability of functional gains following surgery.
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Affiliation(s)
- Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York
| | - Cole A Bortz
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Breton Line
- Rocky Mountain Scoliosis and Spine, Denver, Colorado
| | - Robert Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Richard A Hostin
- Southwest Scoliosis Institute, Baylor Scott and White Medical Center, Plano, Texas
| | - Samantha R Horn
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York
| | - Frank A Segreto
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York
| | - Max Egers
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey L Gum
- Department of Orthopaedic Surgery, Norton Leatherman Spine Center, Louisville, Kentucky
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California, Davis, California
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Frank J Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, Colorado
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Passias PG, Horn SR, Lafage V, Lafage R, Smith JS, Line BG, Protopsaltis TS, Soroceanu A, Bortz C, Segreto FA, Ahmad W, Naessig S, Pierce KE, Brown AE, Alas H, Kim HJ, Daniels AH, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Effect of age-adjusted alignment goals and distal inclination angle on the fate of distal junctional kyphosis in cervical deformity surgery. J Craniovertebr Junction Spine 2021; 12:65-71. [PMID: 33850384 PMCID: PMC8035585 DOI: 10.4103/jcvjs.jcvjs_170_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Age-adjusted alignment targets in the context of distal junctional kyphosis (DJK) development have yet to be investigated. Our aim was to assess age-adjusted alignment targets, reciprocal changes, and role of lowest instrumented level orientation in DJK development in cervical deformity (CD) patients. Methods: CD patients were evaluated based on lowest fused level: cervical (C7 or above), upper thoracic (UT: T1–T6), and lower thoracic (LT: T7–T12). Age-adjusted alignment targets were calculated using published formulas for sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), pelvic tilt (PT), T1 pelvic angle (TPA), and LL-thoracic kyphosis (TK). Outcome measures were cervical and global alignment parameters: Cervical SVA (cSVA), cervical lordosis, C2 slope, C2–T3 angle, C2–T3 SVA, TS-CL, PI-LL, PT, and SVA. Subanalysis matched baseline PI to assess age-adjusted alignment between DJK and non-DJK. Results: Seventy-six CD patients included. By 1Y, 20 patients developed DJK. Non-DJK patients had 27% cervical lowest instrumented vertebra (LIV), 68% UT, and 5% LT. DJK patients had 25% cervical, 50% UT, and 25% LT. There were no baseline or 1Y differences for PI, PI-LL, SVA, TPA, or PT for actual and age-adjusted targets. DJK patients had worse baseline cSVA and more severe 1Y cSVA, C2–T3 SVA, and C2 slope (P < 0.05). The distribution of over/under corrected patients and the offset between actual and ideal alignment for SVA, PT, TPA, PI-LL, and LL-TK were similar between DJK and non-DJK patients. DJK patients requiring reoperation had worse postoperative changes in all cervical parameters and trended toward larger offsets for global parameters. Conclusion: CD patients with severe baseline malalignment went on to develop postoperative DJK. Age-adjusted alignment targets did not capture differences in these populations, suggesting the need for cervical-specific goals.
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Affiliation(s)
- Peter Gust Passias
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Samantha R Horn
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton G Line
- Department of Spine Surgery, Denver International Spine Clinic, Denver, Colorado, USA
| | | | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Canada
| | - Cole Bortz
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Frank A Segreto
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Waleed Ahmad
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Sara Naessig
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Katherine E Pierce
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Avery E Brown
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Haddy Alas
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York City, NY, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Denver, Colorado, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
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Passias PG, Bortz CA, Segreto FA, Horn SR, Pierce KE, Manning J, Vasquez-Montes D, Diebo B, Lafage R, Lafage V. Pelvic Incidence Affects Age-adjusted Alignment Outcomes in a Population of Adult Spinal Deformity. Clin Spine Surg 2021; 34:E51-E56. [PMID: 32568861 DOI: 10.1097/bsd.0000000000001025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/24/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A single-center retrospective cohort study. OBJECTIVE The objective of this study was to assess the effects of patient height and pelvic incidence (PI) on age-adjusted alignment outcomes of surgical adult spinal deformity (ASD) patients. SUMMARY OF BACKGROUND DATA Patient height and PI have yet to be evaluated for their individual effects on achieving age-adjusted alignment targets. METHODS Surgical ASD patients were grouped by percentile (low: <25th; normative: 25th-75th; high: >75th) for height and PI. Correction groups were generated at postoperative follow-up for actual alignment compared with age-adjusted ideal values for pelvic tilt (PT), pelvic incidence minus lumbar lordosis mismatch (PI-LL), and sagittal vertical axis, and PI-adjusted ideal alignment values for sacral slope (SS), as derived from clinically relevant formulas. Means comparison tests assessed differences in rates of matching ideal alignment (±10 y threshold for age-adjusted targets; -7 to 5 degrees measured minus ideal for SS) across height and PI groups. RESULTS Breakdown of all included 198 patients by PI group: low (25%, 38±11 degrees), normative (50%, 57±5 degrees), high (25%, 75±7 degrees). Breakdown of patient height groups: low (25%, 1.52±0.04 m), normative (50% 1.64±0.05 m), and high (25%, 1.79±0.06 m). Overall, 29% of patients met postoperative age-adjusted alignment targets for PT, 23% for PI-LL, and 25% for sagittal vertical axis. Overall, 26% of patients met PI-adjusted SS alignment. There were no differences across patient height groups in rates of achieving adjusted alignment target (all P>0.05). Patients with high PI reached age-adjusted ideal alignment for PT at a lower rate (16%) than patients with normative (33%) or low PI (33%, P=0.056). Of patients that matched at least 1 ideal alignment target, those with high PI showed inferior preoperative to postoperative changes in EuroQol 5-dimension questionnaire as compared with normative and low PI patients (P=0.015). CONCLUSIONS Patients with high PI reached ideal postoperative age-adjusted PT alignment at a lower rate than patients with normative and low PI. Height had no impact on postoperative age-adjusted alignment outcomes. Current postoperative ideal alignment targets may warrant an adjustment to account for PI.
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Affiliation(s)
- Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York
| | - Cole A Bortz
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York
| | - Frank A Segreto
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York
| | - Samantha R Horn
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York
| | | | - Jordan Manning
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York
| | | | - Bassel Diebo
- Department of Orthopedics, SUNY Downstate Medical Center, Brooklyn
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY
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Bortz C, Alas H, Segreto F, Horn SR, Varlotta C, Brown AE, Pierce KE, Ge DH, Vasquez-Montes D, Lafage V, Lafage R, Fischer CR, Gerling MC, Protopsaltis TS, Buckland AJ, Sciubba DM, De La Garza-Ramos R, Passias PG. Complication Risk in Primary and Revision Minimally Invasive Lumbar Interbody Fusion: A Comparable Alternative to Conventional Open Techniques? Global Spine J 2020; 10:619-626. [PMID: 32677572 PMCID: PMC7359676 DOI: 10.1177/2192568219867289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study of prospective patients undergoing minimally invasive lumbar fusion at a single academic institution. OBJECTIVE To assess differences in perioperative outcomes between primary and revision MIS (minimally invasive surgical) lumbar interbody fusion patients and compare with those undergoing corresponding open procedures. METHODS Patients ≥18 years old undergoing lumbar interbody fusion were grouped by surgical technique: MIS or open. Patients within each group were propensity score matched for comorbidities and levels fused. Patient demographics, surgical factors, and perioperative complication incidences were compared between primary and revision cases using means comparison tests, as appropriate. RESULTS Of the 214 lumbar interbody fusion patients included after propensity score matching, 44 (21%) cases were MIS, and 170 (79%) were open. For MIS patients, there were no significant differences between primary and revision cases in estimated blood loss (EBL; 344 vs 299 cm3, P = .682); however, primary cases had longer operative times (301 vs 246 minutes, P = .029). There were no differences in length of stay (LOS), intensive care unit LOS, readmission, and intraoperative or postoperative complications (all P > .05). For open patients, there were no differences between primary and revision cases in EBL (P > .05), although revisions had longer operative times (331 vs 278 minutes, P = .018) and more postoperative complications (61.7% vs 23.8%, P < .001). MIS revision procedures were shorter than open revisions (182 vs 213 minutes, P = .197) with significantly less EBL (294 vs 965 cm3, P < .001), shorter inpatient and intensive care unit LOS, and fewer postoperative complications (all P < .05). CONCLUSIONS Clinical outcomes of revision MIS lumbar interbody fusion were similar to those of primary surgery. Additionally, MIS techniques were associated with less EBL, shorter LOS, and fewer perioperative complications than corresponding open revisions.
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Affiliation(s)
- Cole Bortz
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Haddy Alas
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | | | | | | | | | - David H. Ge
- NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | - Peter G. Passias
- NYU Langone Orthopedic Hospital, New York, NY, USA,Peter G. Passias, Department of Orthopaedic Surgery, New York Spine Institute, NYU Medical Center–Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
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Passias PG, Segreto FA, Bortz CA, Horn SR, Pierce KE, Naessig S, Brown AE, Jackson-Fowl B, Ahmad W, Oh C, Lafage V, Lafage R, Smith JS, Daniels AH, Line BG, Kim HJ, Uribe JS, Eastlack RK, Hamilton DK, Klineberg EO, Burton DC, Hart RAA, Schwab FJ, Shaffrey CI, Ames CP, Bess S. Probability of severe frailty development among operative and nonoperative adult spinal deformity patients: an actuarial survivorship analysis over a 3-year period. Spine J 2020; 20:1276-1285. [PMID: 32320862 DOI: 10.1016/j.spinee.2020.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Little is known of how frailty, a dynamic measure of physiological age, progresses relative to age or disability status. Operative treatment of adult spinal deformity (ASD) may play a role in frailty remediation and maintenance. PURPOSE Compare frailty status, severe frailty development, and factors influencing severe frailty development among ASD patients undergoing operative or nonoperative treatment. DESIGN Retrospective review with maximum follow-up of 3 years. SETTING Prospective, multicenter, ASD database. PARTICIPANTS Patients were consecutively enrolled from 13 participating centers. INCLUSION CRITERIA ≥18 years undergoing either operative or nonoperative treatment for ASD, exclusion criteria: spinal deformity of neuromuscular etiology, presence of active infection, or malignancy. The mean age of the participants analyzed were 54.9 for the operative cohort and 55.0 for the nonoperative cohort. OUTCOMES MEASURES Frailty status, severe frailty development, and factors influencing severe frailty development. METHODS ASD patients (coronal scoliosis ≥20°, sagittal vertical axis (SVA) ≥5 cm, Pelvic Tilt (PT) ≥25°, or thoracic kyphosis ≥60°) >18 y/o, with Base Line (BL) frailty scores were included. Frailty was scored from 0 to 1 (not frail: <0.3, frail 0.3-0.5, severe frailty >0.5) through the use of ASD-frailty index (FI) which has been validated using the International Spine Study Group (ISSG) ASD database, European Spine Study Group ASD database, and the Scoli-RISK-1 Patient Database. The ISSG is funded through research grants from DePuy Synthes and individual donations and supported the current work. Operative (Op) and Nonoperative (Non-Op) patients were propensity matched. T-tests compared frailty among treatment groups and BL, 1, 2, and ≥3 years. An actuarial Kaplan-Meier survivorship analysis with log-rank (Mantel-Cox) test, adjusting for patients lost to follow-up, determined probability of severe frailty development. Multivariate Cox Regressions gauged the effect of sagittal malalignment, patient and surgical details on severe frailty development. RESULTS The analysis includes 472 patients (236 Op, 236 Non-Op) selected by propensity score matching from a cohort of 1,172. Demographics and comorbidities were similar between groups (p>.05). Op exhibited decreased frailty at all follow-up intervals compared with BL (BL: 0.22 vs Y1: 0.18; Y2: 0.16; Y3: 0.15, all p<.001). Non-Op displayed similar frailty from BL to 2Y follow up, and increased frailty at 3Y follow up (0.23 vs 0.25, p=.014). Compared with Non-Op, Op had lower frailty at 1Y (0.18 vs 0.24), 2Y (0.16 vs 0.23), and 3Y (0.15 vs 0.25; all p<.001). Cumulative probability of maintaining nonsevere frailty was (Op: 97.7%, Non-Op: 94.5%) at 1Y, (Op: 95.1%, Non-Op: 90.4%) at 2Y, and (Op: 95.1%, Non-Op: 89.1%) at ≥3Y, (p=.018). Among all patients, baseline depression (hazard ratio: 2.688[1.172-6.167], p=.020), Numeric Rating Scale (NRS) back pain scores (HR: 1.247[1.012-1.537], p=.039), and nonoperative treatment (HR: 2.785[1.167-6.659], p=.021) predicted severe frailty development with having a HR>1.0 and p value<.05. Among operative patients, 6-week postoperative residual SVA malalignment (SRS-Schwab SVA+modifier) (HR: 15.034[1.922-116.940], p=.010) predicted severe frailty development indicated by having a HR>1.0 and p value <.05. CONCLUSIONS Non-Op patients were more likely to develop severe frailty, and at a quicker rate. Baseline depression, increased NRS back pain scores, nonoperative treatment, and postoperative sagittal malalignment at 6-week follow-up significantly predicted severe frailty development. Operative intervention and postoperative sagittal balance appear to play significant roles in frailty remediation and maintenance in ASD patients. Frailty is one factor, in a multifactorial conservation, that may be considered when determining operative or nonoperative values for ASD patients. Operating before the onset of severe frailty, may result in a lower complication risk and better long-term clinical outcomes.
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Affiliation(s)
- Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Frank A Segreto
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Katherine E Pierce
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Sara Naessig
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Avery E Brown
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Brendan Jackson-Fowl
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Waleed Ahmad
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Cheongeun Oh
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Breton G Line
- Department of Orthopedic Surgery, Rocky Mountain Scoliosis and Spine Center, Denver, Colorado, USA
| | - Han Jo Kim
- Deparment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Juan S Uribe
- Department of Neurosurgery, University of South Florida, Tampa, FL, USA
| | | | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert A A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, CO, USA
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Horn SR, Stoltzfus KC, Lehrer EJ, Dawson LA, Tchelebi L, Gusani NJ, Sharma NK, Chen H, Trifiletti DM, Zaorsky NG. Epidemiology of liver metastases. Cancer Epidemiol 2020; 67:101760. [PMID: 32562887 DOI: 10.1016/j.canep.2020.101760] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/22/2020] [Accepted: 05/30/2020] [Indexed: 02/09/2023]
Abstract
AIMS The objectives of this study were to (1) characterize the epidemiology of liver metastases at the time of primary cancer diagnosis (synchronous liver metastases), (2) characterize the incidence trends of synchronous liver metastases from 2010-2015 and (3) assess survival of patients with synchronous liver metastases. METHODS The Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 was queried to obtain cases of patients with liver metastases at the time of primary cancer diagnosis. The primary cancers with an incidence rate of liver metastasis >0.1 are presented in this analysis. RESULTS Among 2.4 million cancer patients, 5.14 % of cancer patients presented with synchronous liver metastases. The most common primary site was breast cancers for younger women (ages 20-50), and colorectal cancers for younger men. As patients get older, a more heterogenous population of the top cancers with liver metastases emerges including esophageal, stomach, small intestine, melanoma, and bladder cancer in addition to the large proportion of lung, pancreatic, and colorectal cancers. The 1-year survival of all patients with liver metastases was 15.1 %, compared to 24.0 % in those with non-hepatic metastases. Regression analysis showed that the presence of liver metastasis was associated with reduced survival, particularly in patients with cancers of the testis, prostate, breast, and anus, and in those with melanoma. CONCLUSIONS The most common primary sites for patients with liver metastases varied based on age at diagnosis. Survival for patients with liver metastasis was significantly decreased as compared to patients without liver metastasis.
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Affiliation(s)
- Samantha R Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Kelsey C Stoltzfus
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura A Dawson
- Department of Radiation Oncology, University of Toronto, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario Canada
| | - Leila Tchelebi
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Niraj J Gusani
- Department of Surgery, Penn State College of Medicine, Hershey, PA, USA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Navesh K Sharma
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Hanbo Chen
- Department of Radiation Oncology, Amsterdam University Medical Centers - Location VUmc, Amsterdam, Netherlands
| | | | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA; Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
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Passias PG, Horn SR, Segreto FA, Bortz CA, Pierce KE, Vasquez-Montes D, Moon J, Varlotta CG, Raman T, Frangella NJ, Stekas N, Lafage R, Lafage V, Gerling MC, Protopsaltis TS, Buckland AJ, Fischer CR. ODI Cannot Account for All Variation in PROMIS Scores in Patients With Thoracolumbar Disorders. Global Spine J 2020; 10:399-405. [PMID: 32435558 PMCID: PMC7222681 DOI: 10.1177/2192568219851478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
STUDY DESIGN Retrospective review of single institution. OBJECTIVE To assess the relationship between Patient-Reported Outcomes Measurement Information System (PROMIS) and Oswestry Disability Index (ODI) scores in thoracolumbar patients. METHODS Included: Patients ≥18 years with a thoracolumbar spine condition (spinal stenosis, disc herniation, low back pain, disc degeneration, spondylolysis). Bivariate correlations assessed the linear relationships between ODI and PROMIS (Physical Function, Pain Intensity, and Pain Interference). Correlation cutoffs assessed patients with high and low correlation between ODI and PROMIS. Linear regression predicted the relationship of ODI to PROMIS. RESULTS A total of 206 patients (age 53.7 ± 16.6 years, 49.5% female) were included. ODI correlated with PROMIS Physical Function (r = -0.763, P < .001), Pain Interference (r = 0.800, P < .001), and Pain Intensity (r = 0.706, P < .001). ODI strongly predicted PROMIS for Physical Function (R 2 = 0.58, P < .001), Pain Intensity (R 2 = 0.50, P < .001), and Pain Interference (R 2 = 0.64, P < .001); however, there is variability in PROMIS that ODI cannot account for. ODI questions about sitting and sleeping were weakly correlated across the 3 PROMIS domains. Linear regression showed overall ODI score as accounting for 58.3% (R 2 = 0.583) of the variance in PROMIS Physical Function, 63.9% (R 2 = 0.639) of the variance in Pain Interference score, and 49.9% (R 2 = 0.499) of the variance in Pain Intensity score. CONCLUSIONS There is a large amount of variability with PROMIS that cannot be accounted for with ODI. ODI questions regarding walking, social life, and lifting ability correlate strongly with PROMIS while sitting, standing, and sleeping do not. These results reinforce the utility of PROMIS as a valid assessment for low back disability, while indicating the need for further evaluation of the factors responsible for variation between PROMIS and ODI.
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Affiliation(s)
- Peter G. Passias
- NYU Langone Orthopedic Hospital, Manhattan, NY, USA,Peter G. Passias, NYU School of Medicine, Division of Spinal Surgery, Department of Orthopaedic and Neurological Surgery, New York Spine Institute, 301 East 17th Street, New York, NY 10003, USA.
| | | | | | | | | | | | - John Moon
- NYU Langone Orthopedic Hospital, Manhattan, NY, USA
| | | | - Tina Raman
- NYU Langone Orthopedic Hospital, Manhattan, NY, USA
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Horn SR, Ayres EW, Segreto FA, Brown AE, Bortz C, Ihejirika Y, Pierce K, Alas H, Chern I, Passias PG. Ossification of the Posterior Longitudinal Ligament in Cervical Spine Cases Trends in Surgical Treatments and Outcomes in the US from 2005 to 2013. Bull Hosp Jt Dis (2013) 2020; 78:108-114. [PMID: 32510296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Ossification of the posterior longitudinal ligament (OPLL) is characterized by ectopic bone formation within the ligament and can elicit cervical spinal canal stenosis. Surgical treatment for OPLL is debated in the literature. This study examined nationwide data to estimate the prevalence of cervical OPLL (C-OPLL) and investigated trends in surgical treatment and outcomes. METHODS A retrospective cross-sectional study was conducted of the National Inpatient Sample (NIS) database for patients with a diagnosis code for C-OPLL (ICD-9-CM 723.7) from 2005 to 2013. NIS supplied hospital- and yearadjusted weights allowed for accurate assessment of prevalence. Descriptive statistics assessed patient demographics, comorbidities, surgical factors, and complications. Trends were analyzed using chi-squared, ANOVA, and independent sample t-tests. RESULTS A total of 4,601 C-OPLL discharges were identified (56.7 years, 43% female). The prevalence of C-OPLL has increased from 0.7/100,000 in 2005 to 2.1/100,000 in 2013. Among hospitalized C-OPLL patients, 89.1% underwent surgery, with 62.1% undergoing an anterior-only (A) approach, 21.5% posterior-only (P), and 16.4% combined (AP). Rates of anterior- and decompression-only surgeries have declined since 2005, from 67.5% to 44.4% and 21.6% to 14.8%, respectively (p < 0.001 for both). Corpectomy rates have dramatically increased, from 3.6% to 27.2% (p < 0.001). Overall complication rates have increased 2.5% since 2005 (p < 0.001) with higher rates of dysphagia (0.7%) and dural tears (5.6%) associated with A-only surgeries (p < 0.001 for both). The overall mortality rate was 0.8%, with P surgery associated with the highest rate, 1.6% (p = 0.002). CONCLUSIONS The rate of hospitalization for C-OPLL has increased over the last decade as have morbidity rates for C-OPLL discharges. Anterior-only surgeries were associated with higher complication rates. Surgical rates have remained constantsince 2005, butrates of anterior-only and decompression-only procedures have decreased in favor of posterior-only and combined-approach surgeries.
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Horn SR, Segreto FA, Alas H, Bortz C, Jackson-Fowl B, Brown AE, Pierce KE, Vasquez-Montes D, Egers MI, Line BG, Oh C, Moon J, De la Garza Ramos R, Vira S, Diebo BG, Frangella NJ, Stekas N, Shepard NA, Horowitz JA, Hassanzadeh H, Bendo JA, Lafage R, Lafage V, Passias PG. Hospital-acquired conditions occur more frequently in elective spine surgery than for other common elective surgical procedures. J Clin Neurosci 2020; 76:36-40. [PMID: 32331939 DOI: 10.1016/j.jocn.2020.04.067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 02/18/2020] [Accepted: 04/12/2020] [Indexed: 12/17/2022]
Abstract
Hospital-acquired conditions (HACs) have been the focus of recent initiatives by the Centers for Medicare and Medicaid Services in an effort to improve patient safety and outcomes. Spine surgery can be complex and may carry significant comorbidity burden, including so called "never events." The objective was to determine the rates of common HACs that occur within 30-days post-operatively for elective spine surgeries and compare them to other common surgical procedures. Patients: >18 y/o undergoing elective spine surgery were identified in the American College of Surgeons' NSQIP database from 2005 to 2013. Patients were stratified by whether they experienced >1 HAC, then compared to those undergoing other procedures including bariatric surgery, THA and TKA. Of the 90,551 spine surgery patients, 3021 (3.3%) developed at least one HAC. SSI was the most common (1.4%), followed by UTI (1.3%), and VTE (0.8%). Rates of HACs in spine surgery were significantly higher than other elective procedures including bariatric surgery (2.8%) and THA (2.8%) (both p < 0.001). Spine surgery and TKA patients had similar rates of HACs(3.3% vs 3.4%, p = 0.287), though spine patients experienced higher rates of SSI (1.4%vs0.8%, p < 0.001) and UTI (1.3%vs1.1%, p < 0.001) but lower rates of VTE (0.8%vs1.6%, p < 0.001). Spine surgery patients had lower rates of HACs overall (3.3%vs5.9%) when compared to cardiothoracic surgery patients (p < 0.001). When compared to other surgery types, spine procedures were associated with higher HACs than bariatric surgery patients and knee and hip arthroplasties overall but lower HAC rates than patients undergoing cardiothoracic surgery.
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Affiliation(s)
- Samantha R Horn
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Frank A Segreto
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Haddy Alas
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Cole Bortz
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | - Avery E Brown
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Katherine E Pierce
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | - Max I Egers
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Breton G Line
- Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Cheongeun Oh
- Department of Population Health, NYU Langone Medical Center, New York, NY, USA
| | - John Moon
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | - Shaleen Vira
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Deparment of Orthopedic Surgery, SUNY Downstate, New York, NY, USA
| | | | - Nicholas Stekas
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Nicholas A Shepard
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Jason A Horowitz
- Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Hamid Hassanzadeh
- Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - John A Bendo
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY, USA.
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Singh R, Stoltzfus KC, Chen H, Louie AV, Lehrer EJ, Horn SR, Palmer JD, Trifiletti DM, Brown PD, Zaorsky NG. Epidemiology of synchronous brain metastases. Neurooncol Adv 2020; 2:vdaa041. [PMID: 32363344 PMCID: PMC7182307 DOI: 10.1093/noajnl/vdaa041] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background The objectives of this study were to characterize (1) epidemiology of brain metastases at the time of primary cancer diagnosis, (2) incidence and trends of synchronous brain metastases from 2010 to 2015, and (3) overall survival (OS) of patients with synchronous brain metastases. Methods A total of 42 047 patients with synchronous brain metastases from 2010 to 2015 were identified from the Surveillance, Epidemiology, and End Results database. Descriptive analysis was utilized to analyze demographics and incidence. The Kaplan-Meier method and a Cox proportional hazards model were utilized to evaluate potential prognostic factors for OS. Results The majority of patients were diagnosed from age older than 50 (91.9%). Common primary sites included lung (80%), melanoma (3.8%), breast (3.7%), and kidney/renal pelvis (3.0%). Among pediatric patients, common primaries included kidney/renal pelvis and melanomas. The incidence was roughly 7.3 persons/100 000. Synchronous brain metastases were associated with significantly poorer OS compared to extracranial metastases alone (hazard ratio [HR] =1.56; 95% CI: 1.54-1.58; P < .001). Among patients with brain metastases, male gender (HR = 1.60 vs 1.52), age older than 65 years (HR = 1.60 vs 1.46), synchronous liver, bone, or lung metastases (HR = 1.61 vs 1.49), and earlier year of diagnosis (HR = 0.98 for each year following 2010) were associated with significantly poorer OS. Conclusions The vast majority of brain metastases are from lung primaries. Synchronous brain metastases are associated with poorer OS compared to extracranial metastases alone.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA
| | - Kelsey C Stoltzfus
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Hanbo Chen
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre-Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Samantha R Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Joshua D Palmer
- Department of Radiation Oncology, The James Cancer Hospital at the Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Paul D Brown
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania, USA.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
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22
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Horn SR, Stoltzfus KC, Mackley HB, Lehrer EJ, Zhou S, Dandekar SC, Fox EJ, Rizk EB, Trifiletti DM, Rao PM, Zaorsky NG. Long-term causes of death among pediatric patients with cancer. Cancer 2020; 126:3102-3113. [PMID: 32298481 DOI: 10.1002/cncr.32885] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/23/2020] [Accepted: 03/09/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND The objectives of this study were to characterize the risk of death (1) from the primary cancer vs competing cause of death; and (2) from various causes of death vs the general poplation. The relative risk of death after a pediatric cancer diagnosis versus the general population and the risk of death from a primary cancer diagnosis versus competing causes of death. METHODS This retrospective, population-based study used the Surveillance, Epidemiology, and End Results database (1980-2015) and included patients aged 0 to 19 years at the time of diagnosis. Observed deaths were calculated; the risk of death versus the general population was assessed with standardized mortality ratios (SMRs). Competing risk models for the cause of death were performed. RESULTS There were 58,356 patients who were diagnosed, and the mortality rate was 22.8%. To assess causes of death, 6996 patients who died during the study period were included (45,580 total person-years at risk): 5128 (73%) died of their primary cancer, and 1868 (27%) died of a competing cause. Among all patients, the rate of death from the index cancer was higher than the rate of death from another cause within the first 5 years after diagnosis. The risk of death from a nonprimary cancer began to supersede the rate of death from the primary cancer 10 years after diagnosis for patients with germ cell tumors, lymphomas, and sarcomas. SMRs for the primary cancer were highest within the first 5 years after diagnosis for all cancers (SMRs, 100-50,000; P < .0001). The risk of death from competing causes (heart disease, suicide, and sepsis) was elevated (SMR, >100; P < .001). The risk of dying of heart disease was high, especially for patients with astrocytomas (SMR, 47.84; 95% confidence interval [CI], 27.87-76.59) and neuroblastomas (SMR, 98.59; 95% CI, 47.28-181.32). The risk of dying of suicide was high in most patients, particularly for those with osteosarcomas (SMR, 111.40; 95% CI, 2.82-620.69), Hodgkin lymphomas (SMR, 62.35; 95% CI, 34.89-102.83), and gonadal germ cell tumors (SMR, 28.97; 95% CI, 12.51-57.09). CONCLUSIONS The cause of death for patients with gonadal germ cell tumors, lymphomas, and sarcomas is more commonly a secondary cancer or noncancerous cause than the primary disease; their risk of death from competing causes (heart disease, suicide, and sepsis) rises throughout life.
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Affiliation(s)
- Samantha R Horn
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Kelsey C Stoltzfus
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Heath B Mackley
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Eric J Lehrer
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shouhao Zhou
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Smita C Dandekar
- Department of Pediatrics, Division of Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Edward J Fox
- Department of Orthopaedics and Rehabilitation, Penn State Hershey College of Medicine, Hershey, Pennsylvania
| | - Elias B Rizk
- Department of Neurosurgery, Penn State Cancer Institute, Hershey, Pennsylvania
| | | | - Pooja M Rao
- Department of Pediatrics, Division of Hematology/Oncology, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania.,Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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Horn SR, Passias PG, Oh C, Lafage V, Lafage R, Smith JS, Line B, Anand N, Segreto FA, Bortz CA, Scheer JK, Eastlack RK, Deviren V, Mummaneni PV, Daniels AH, Park P, Nunley PD, Kim HJ, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP, _ _. Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery. J Neurosurg Spine 2020; 32:182-190. [DOI: 10.3171/2019.7.spine18651] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVECervical deformity (CD) correction is clinically challenging. There is a high risk of developing complications with these highly complex procedures. The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor outcome following CD surgery.METHODSThe authors performed a retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: cervical kyphosis (C2–7 Cobb angle > 10°), cervical scoliosis (coronal Cobb angle > 10°), C2–7 sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle (CBVA) > 25°. Patients were categorized based on having an overall poor outcome or not. Health-related quality of life measures consisted of Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale scores. A poor outcome was defined as having all 3 of the following categories met: 1) radiographic poor outcome: deterioration or severe radiographic malalignment 1 year postoperatively for cSVA or T1 slope–cervical lordosis mismatch (TS-CL); 2) clinical poor outcome: failing to meet the minimum clinically important difference (MCID) for NDI or having a severe mJOA Ames modifier; and 3) complications/reoperation poor outcome: major complication, death, or reoperation for a complication other than infection. Univariate logistic regression followed by multivariate regression models was performed, and internal validation was performed by calculating the area under the curve (AUC).RESULTSIn total, 89 patients with CD were included (mean age 61.9 years, female sex 65.2%, BMI 29.2 kg/m2). By 1 year postoperatively, 18 (20.2%) patients were characterized as having an overall poor outcome. For radiographic poor outcomes, patients’ conditions either deteriorated or remained severe for TS-CL (73% of patients), cSVA (8%), horizontal gaze (34%), and global SVA (28%). For clinical poor outcomes, 80% and 60% of patients did not reach MCID for EQ-5D and NDI, respectively, and 24% of patients had severe symptoms (mJOA score 0–11). For the complications/reoperation poor outcome, 28 patients experienced a major complication, 11 underwent a reoperation, and 1 had a complication-related death. Of patients with a poor clinical outcome, 75% had a poor radiographic outcome; 35% of poor radiographic and 37% of poor clinical outcome patients had a major complication. A poor outcome was predicted by the following combination of factors: osteoporosis, baseline neurological status, use of a transition rod, number of posterior decompressions, baseline pelvic tilt, T2–12 kyphosis, TS-CL, C2–T3 SVA, C2–T1 pelvic angle (C2 slope), global SVA, and number of levels in maximum thoracic kyphosis. The final model predicting a poor outcome (AUC 86%) included the following: osteoporosis (OR 5.9, 95% CI 0.9–39), worse baseline neurological status (OR 11.4, 95% CI 1.8–70.8), baseline pelvic tilt > 20° (OR 0.92, 95% CI 0.85–0.98), > 9 levels in maximum thoracic kyphosis (OR 2.01, 95% CI 1.1–4.1), preoperative C2–T3 SVA > 5.4 cm (OR 1.01, 95% CI 0.9–1.1), and global SVA > 4 cm (OR 3.2, 95% CI 0.09–10.3).CONCLUSIONSOf all CD patients in this study, 20.2% had a poor overall outcome, defined by deterioration in radiographic and clinical outcomes, and a major complication. Additionally, 75% of patients with a poor clinical outcome also had a poor radiographic outcome. A poor overall outcome was most strongly predicted by severe baseline neurological deficit, global SVA > 4 cm, and including more of the thoracic maximal kyphosis in the construct.
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Affiliation(s)
- Samantha R. Horn
- 1Department of Orthopaedics, NYU Langone Medical Center–Orthopaedic Hospital, New York, New York
| | - Peter G. Passias
- 1Department of Orthopaedics, NYU Langone Medical Center–Orthopaedic Hospital, New York, New York
| | - Cheongeun Oh
- 1Department of Orthopaedics, NYU Langone Medical Center–Orthopaedic Hospital, New York, New York
| | - Virginie Lafage
- 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S. Smith
- 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Breton Line
- 4Denver International Spine Center, Presbyterian/St. Luke’s Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | - Neel Anand
- 5Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Frank A. Segreto
- 1Department of Orthopaedics, NYU Langone Medical Center–Orthopaedic Hospital, New York, New York
| | - Cole A. Bortz
- 1Department of Orthopaedics, NYU Langone Medical Center–Orthopaedic Hospital, New York, New York
| | - Justin K. Scheer
- 6Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Robert K. Eastlack
- 7Department of Orthopaedic Surgery, Scripps Health, La Jolla, California
| | - Vedat Deviren
- 8Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Praveen V. Mummaneni
- 8Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Alan H. Daniels
- 9Department of Orthopaedic Surgery, Brown University Medical Center, Providence, Rhode Island
| | - Paul Park
- 10Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Pierce D. Nunley
- 11Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, Louisiana
| | - Han Jo Kim
- 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eric O. Klineberg
- 12Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Douglas C. Burton
- 13Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A. Hart
- 14Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington; and
| | - Frank J. Schwab
- 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- 4Denver International Spine Center, Presbyterian/St. Luke’s Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | - Christopher I. Shaffrey
- 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher P. Ames
- 15Department of Neurological Surgery, University of California, San Francisco, California
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Passias PG, Segreto FA, Horn SR, Lafage V, Lafage R, Smith JS, Naessig S, Bortz C, Klineberg EO, Diebo BG, Sciubba DM, Neuman BJ, Hamilton DK, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Nunley P, Ames CP. Fatty infiltration of the cervical extensor musculature, cervical sagittal balance, and clinical outcomes: An analysis of operative adult cervical deformity patients. J Clin Neurosci 2020; 72:134-141. [PMID: 31926664 DOI: 10.1016/j.jocn.2019.12.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/20/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess preliminary associations between fatty-infiltration (FI) of cervical spine extensor musculature, cervical sagittal balance, and clinical outcomes in cervical deformity (CD) patients. METHODS Operative CD patients (C2-C7 Cobb > 10°, CL > 10°, cSVA > 4 cm, or CBVA > 25°) with pre-operative (BL) MRIs and 1-year (1Y) post-operative MRIs or CTs were assessed for fatty-infiltration of cervical extensor musculature, using dedicated imaging software at each C2-C7 intervertebral level and the apex of deformity (apex). FI was gauged as a ratio of fat-free-muscle-cross-sectional-area (FCSA) over total-muscle-CSA (TCSA), with lower ratio values indicating greater FI. BL-1Y associations between FI, sagittal alignment, and clinical outcomes were assessed using appropriate parametric and non-parametric tests. RESULTS 22 patients were included (Age 59.22, 71.4%F, BMI 29.2, CCI:0.75, Frailty: 0.43). BL deformity presentation: TS-CL: 29.0°, C2-C7 Sagittal Cobb:-1.6°, cSVA:30.4 mm. No correlations were observed between BL fatty-infiltration, sagittal alignment, frailty, or clinical outcomes (p > 0.05). Following surgical correction, C2-C7 (BL: 0.59 vs 1Y:0.67, p = 0.005) and apex (BL: 0.59 vs. 1Y: 0.66, p = 0.33) fatty-infiltration decreased. Achievement of lordotic curvature correlated with C2-C7 fatty infiltration reduction (Rs: 0.495, p < 0.05), and patients with residual postoperative TS-CL and cSVA malalignment were associated with greater apex fatty-infiltration (Rs: -0.565, -0.561; p < 0.05). C2-C7 FI improvement was associated with NRS back pain reduction (Rs: -0.630, p < 0.05), and greater apex fatty-infiltration at BL was associated with minor perioperative complication occurrence (Rs: 0.551, p = 0.014). CONCLUSIONS Deformity correction and sagittal balance appear to influence the reestablishment of cervical muscle tone from C2-C7 and reduction of back pain for severely frail CD patients. This analysis helps to understand cervical extensor musculature's role amongst CD patients.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA.
| | - Frank A Segreto
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Sara Naessig
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Cole Bortz
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brian J Neuman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas C Burton
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robert A Hart
- Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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Horn SR, Pierce KE, Oh C, Segreto FA, Egers M, Bortz C, Vasquez-Montes D, Lafage R, Lafage V, Vira S, Steinmetz L, Ge DH, Buza JA, Moon J, Diebo BG, Alas H, Brown AE, Shepard NA, Hassanzadeh H, Passias PG. Predictors of Hospital-Acquired Conditions Are Predominately Similar for Spine Surgery and Other Common Elective Surgical Procedures, With Some Key Exceptions. Global Spine J 2019; 9:717-723. [PMID: 31552152 PMCID: PMC6745634 DOI: 10.1177/2192568219826083] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
STUDY DESIGN Retrospective review of a prospectively collected database. OBJECTIVE To predict the occurrence of hospital-acquired conditions (HACs) 30-days postoperatively and to compare predictors of HACs for spine surgery with other common elective surgeries. METHODS Patients ≥18 years undergoing elective spine surgery were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2005 to 2013. Outcome measures included any HACs: superficial or deep surgical site infection (SSI), venous thromboembolism (VTE), urinary tract infection (UTI). Spine surgery patients were compared with those undergoing other common procedures. Random forest followed by multivariable regression analysis was used to determine risk factors for the occurrence of HACs. RESULTS A total of 90 551 elective spine surgery patients, of whom 3021 (3.3%) developed at least 1 HAC, 1.4% SSI, 1.3% UTI, and 0.8% VTE. The occurrence of HACs for spine patients was predicted with high accuracy (area under the curve [AUC] 77.7%) with the following variables: female sex, baseline functional status, hypertension, history of transient ischemic attack (TIA), quadriplegia, steroid use, preoperative bleeding disorders, American Society of Anesthesiologists (ASA) class, operating room duration, operative time, and level of residency supervision. Functional status and hypertension were HAC predictors for total knee arthroplasty (TKA), bariatric, and cardiothoracic patients. ASA class and operative time were predictors for most surgery cohorts. History of TIA, preoperative bleeding disorders, and steroid use were less predictive for most other common surgical cohorts. CONCLUSIONS Occurrence of HACs after spine surgery can be predicted with demographic, clinical, and surgical factors. Predictors for HACs in surgical spine patients, also common across other surgical groups, include functional status, hypertension, and operative time. Understanding the baseline patient risks for HACs will allow surgeons to become more effective in their patient selection for surgery.
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Affiliation(s)
| | | | - Cheongeun Oh
- NYU Langone Orthopaedic Hospital, New York, NY, USA
| | | | - Max Egers
- NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - Cole Bortz
- NYU Medical Center, NY Spine Institute, New York, NY, USA
| | | | | | | | - Shaleen Vira
- NYU Langone Orthopaedic Hospital, New York, NY, USA
| | | | - David H. Ge
- NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - John A. Buza
- NYU Langone Orthopaedic Hospital, New York, NY, USA
| | - John Moon
- NYU Langone Orthopaedic Hospital, New York, NY, USA
| | | | - Haddy Alas
- NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Avery E. Brown
- NYU Medical Center, NY Spine Institute, New York, NY, USA
| | | | | | - Peter G. Passias
- NYU Medical Center, NY Spine Institute, New York, NY, USA,Peter G. Passias, Division of Spinal Surgery,
Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301
East 17th Street, New York, NY 10003, USA.
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26
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Pierce KE, Horn SR, Jain D, Segreto FA, Bortz C, Vasquez-Montes D, Zhou PL, Moon J, Steinmetz L, Varlotta CG, Frangella NJ, Stekas N, Ge DH, Hockley A, Diebo BG, Vira S, Alas H, Brown AE, Lafage R, Lafage V, Schwab FJ, Koller H, Buckland AJ, Gerling MC, Passias PG. The Impact of Adult Thoracolumbar Spinal Deformities on Standing to Sitting Regional and Segmental Reciprocal Alignment. Int J Spine Surg 2019; 13:308-316. [PMID: 31531280 DOI: 10.14444/6042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Regional and segmental changes of the lumbar spine have previously been described as patients transition from standing to sitting; however, alignment changes in the cervical and thoracic spine have yet to be investigated. So, the aim of this study was to assess cervical and thoracic regional and segmental changes in patients with thoracolumbar deformity versus a nondeformed thoracolumbar spine population. Methods This study was a retrospective cohort study of a single center's database of full-body stereoradiographic imaging and clinical data. Patients were ≥ 18 years old with nondeformed spines (nondegenerative, nondeformity spinal pathologies) or thoracolumbar deformity (ASD: PI-LL > 10°). Patients were propensity-score matched for age and maximum hip osteoarthritis grade and were stratified by Scoliosis Research Society (SRS)-Schwab classification by PI-LL, SVA, and PT. Patients with lumbar transitional anatomy or fusions were excluded. Outcome measures included changes between standing and sitting in global alignment parameters: sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis (PI-LL), pelivc tilt (PT), thoracic kyphosis, cervical alignment, cervical SVA, C2-C7 lordosis (CL), T1 slop minus CL (TS-CL), and segmental alignment from C2 to T12. Another analysis was performed using patients with cervical and thoracic segmental measurements. Results A total of 338 patients were included (202 nondeformity, 136 ASD). After propensity-score matching, 162 patients were included (81 nondeformity, 81 ASD). When categorized by SRS-Schwab classification, all nondeformity patients were nonpathologically grouped for PI-LL, SVA, and PT, whereas ASD patients had mix of moderately and markedly deformed modifiers. There were significant differences in pelvic and global spinal alignment changes from standing to sitting between nondeformity and ASD patients, particularly for SVA (nondeformed: 49.5 mm versus ASD: 27.4 mm; P < .001) and PI-LL (20.12° versus 13.01°, P < .001). With application of the Schwab classification system upon the cohort, PI-LL (P = .040) and SVA (P = .007) for severely classified deformity patients had significantly less positional alignment change. In an additional analysis of patients with segmental measurements from C2 to T12, nondeformity patients showed significant mobility of T2-T3 (-0.99° to -0.54°, P = .023), T6-T7 (-3.39° to -2.89°, P = .032), T7-T8 (-2.68° to -2.23°, P = .048), and T10-T11 (0.31° to 0.097°, P = .006) segments from standing to sitting. ASD patients showed mobility of the C6-C7 (1.76° to 3.45°, P < .001) and T11-T12 (0.98° to 0.54°, P = 0.014) from standing to sitting. The degree of mobility between nondeformity and ASD patients was significantly different in C6-C7 (-0.18° versus 1.69°, P = .003), T2-T3 (0.45° versus -0.27°, P = .034), and T10-T11 (0.45° versus -0.30°, P = .001) segments. With application of the Schwab modifier system upon the cohort, mobility was significant in the C6-C7 (nondeformed: 0.18° versus moderately deformed: 2.12° versus markedly deformed: 0.92°, P = .039), T2-T3 (0.45° versus -0.08° versus -0.63°, P = .020), T6-T7 (0.48° versus 0.36° versus -1.85°, P = .007), and T10-T11 (0.45° versus -0.21° versus -0.23°, P = .009) segments. Conclusions Nondeformity patients and ASD patients have significant differences in mobility of global spinopelvic parameters as well as segmental regions in the cervical and thoracic spine between sitting and standing. This study aids in our understanding of flexibility and compensatory mechanisms in deformity patients, as well as the possible impact on unfused segments when considering deformity corrective surgery.
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Affiliation(s)
- Katherine E Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Samantha R Horn
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Deeptee Jain
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Frank A Segreto
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Cole Bortz
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Peter L Zhou
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - John Moon
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Leah Steinmetz
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | | | - Nicholas J Frangella
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Nicholas Stekas
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - David H Ge
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Aaron Hockley
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Shaleen Vira
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Haddy Alas
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Avery E Brown
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
| | - Renaud Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Frank J Schwab
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Heiko Koller
- Schön Kliniken Nürnberg Fürth-Center for Spinal and Scoliosis Therapy, Fürth, Germany
| | - Aaron J Buckland
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Michael C Gerling
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, New York
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York
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27
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Passias PG, Horn SR, Oh C, Lafage R, Lafage V, Smith JS, Line B, Protopsaltis TS, Yagi M, Bortz CA, Segreto FA, Alas H, Diebo BG, Sciubba DM, Kelly MP, Daniels AH, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Predicting the Occurrence of Postoperative Distal Junctional Kyphosis in Cervical Deformity Patients. Neurosurgery 2019; 86:E38-E46. [DOI: 10.1093/neuros/nyz347] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/18/2019] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
BACKGROUND
Distal junctional kyphosis (DJK) development after cervical deformity (CD)-corrective surgery is a growing concern for surgeons and patients. Few studies have investigated risk factors that predict the occurrence of DJK.
OBJECTIVE
To predict DJK development after CD surgery using predictive modeling.
METHODS
CD criteria was at least one of the following: C2-C7 Coronal/Cobb > 10°, C2-7 sagittal vertical axis (cSVA) > 4 cm, chin-brow vertical angle > 25°. DJK was defined as the development of an angle <−10° from the end of fusion construct to the second distal vertebra, and change in this angle by <−10° from baseline to postoperative. Baseline demographic, clinical, and surgical information were used to predict the occurrence of DJK using generalized linear modeling both as one overall model and as submodels using baseline demographic and clinical predictors or surgical predictors.
RESULTS
One hundred seventeen CD patients were included. At any postoperative visit up to 1 yr, 23.1% of CD patients developed DJK. DJK was predicted with high accuracy using a combination of baseline demographic, clinical, and surgical factors by the following factors: preoperative neurological deficit, use of transition rod, C2-C7 lordosis (CL)<−12°, T1 slope minus CL > 31°, and cSVA > 54 mm. In the model using only baseline demographic/clinical predictors of DJK, presence of comorbidities, presence of baseline neurological deficit, and high preoperative C2-T3 angle were included in the final model (area under the curve = 87%). The final model using only surgical predictors for DJK included combined approach, posterior upper instrumented vertebrae below C4, use of transition rod, lack of anterior corpectomy, more than 3 posterior osteotomies, and performance of a 3-column osteotomy.
CONCLUSION
Preoperative assessment and consideration should be given to these factors that are predictive of DJK to mitigate poor outcomes.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Samantha R Horn
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Cheongeun Oh
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Breton Line
- Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | | | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Cole A Bortz
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Frank A Segreto
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Haddy Alas
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University Medical Center, Providence, Rhode Island
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Shay Bess
- Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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28
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Passias PG, Horn SR, Jalai CM, Ramchandran S, Poorman GW, Kim HJ, Smith JS, Sciubba D, Soroceanu A, Ames CP, Hamilton DK, Eastlack R, Burton D, Gupta M, Bess S, Lafage V, Schwab F. Cervical Alignment Changes in Patients Developing Proximal Junctional Kyphosis Following Surgical Correction of Adult Spinal Deformity. Neurosurgery 2019; 83:675-682. [PMID: 29040759 DOI: 10.1093/neuros/nyx479] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/25/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Proximal junctional kyphosis (PJK) following adult spinal deformity (ASD) surgery is a well-documented complication, but associations between radiographic PJK and cervical malalignment onset remain unexplored. OBJECTIVE To study cervical malalignment in ASD surgical patients that develop PJK. METHODS Retrospective review of prospective multicenter database. Inclusion: primary ASD patients (≥5 levels fused, upper instrumented vertebra [UIV] at T2 or above, and 1-yr minimum follow-up) without baseline cervical deformity (CD), defined as ≥2 of the following criteria: T1 slope minus cervical lordosis < 20°, cervical sagittal vertical axis < 4 cm, C2-C7 cervical lordosis < 10°. PJK presence (<10° change in UIV and UIV + 2 kyphosis) and angle were identified 1 yr postoperative. Propensity score matching between PJK and nonPJK groups controlled for baseline alignment. Preoperative and 1-yr postoperative cervical alignment were compared between PJK and nonPJK patients. RESULTS One hundred sixty-three patients without baseline CD (54.9 yr, 83.9% female) were included. PJK developed in 60 (36.8%) patients, with 27 (45%) having UIV above T7. PJK patients had significantly greater baseline T1 slope in unmatched and propensity score matching comparisons (P < .05). At 1 yr postoperative, PJK patients had significantly higher T1 slope (P < .001), C2-T3 Cobb (P = .04), and C2-T3 sagittal vertical axis (P = .02). New-onset CD rate in PJK patients was 15%, and 16.5% in nonPJK patients (P > .05). Increased PJK magnitude was associated with increasing T1 slope and C2-T3 SVA (P < .05). CONCLUSION Patients who develop PJK following surgical correction of ASD have a 15% incidence of development of new-onset CD. Patients developing PJK following surgical correction of ASD tend to have an increased preoperative T1 slope. Increased progression of C2-T3 Cobb angle and C2-T3 SVA are associated with development of PJK following surgical correction of thoracolumbar deformity.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York
| | - Subaraman Ramchandran
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York
| | - Gregory W Poorman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, New York
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Douglas Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, Colorado
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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29
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Horn SR, Passias PG, Bortz CA, Pierce KE, Lafage V, Lafage R, Brown AE, Alas H, Smith JS, Line B, Deviren V, Mundis GM, Kelly MP, Kim HJ, Protopsaltis T, Daniels AH, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Predicting extended operative time and length of inpatient stay in cervical deformity corrective surgery. J Clin Neurosci 2019; 69:206-213. [PMID: 31402263 DOI: 10.1016/j.jocn.2019.07.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022]
Abstract
It's increasingly common for surgeons to operate on more challenging cases and higher risk patients, resulting in longer op-time and inpatient LOS. Factors predicting extended op-time and LOS for cervical deformity (CD) patients are understudied. This study identified predictors of extended op-time and length of stay (LOS) after CD-corrective surgery. CD patients with baseline (BL) radiographic data were included. Patients were stratified by extended LOS (ELOS; >75th percentile) and normal LOS (N-LOS; <75th percentile). Op-time analysis excluded staged cases, cases >12 h. A Conditional Variable Importance Table used non-replacement sampling set of Conditional Inference trees to identify influential factors. Mean comparison tests compared LOS and op-time for top factors. 142 surgical CD patients (61 yrs, 62%F, 8.2 levels fused). Op-time and LOS were 358 min and 7.2 days; 30% of patients experienced E-LOS (14 ± 13 days). Overlapping predictors of E-LOS and op-time included levels fused (>7 increased LOS 2.7 days; >5 increased op-time 96 min, P < 0.001), approach (anterior reduced LOS 3.0 days; combined increased op-time 69 min, P < 0.01), BMI (>38 kg/m2 increased LOS 8.1 days; >39 kg/m2 increased op-time 17 min), and osteotomy (LOS 2.0 days, op-time 62 min, P < 0.005). BL cervical parameters increased LOS and op-time: cSVA (>42 mm increased LOS; >50 mm increased op-time, P < 0.030), C0 slope (>@-0.9° increased LOS, >0.3° increased op-time, P < 0.003.) Additional op-time predictors: prior cervical surgery (p = 0.004) and comorbidities (P = 0.015). Other predictors of E-LOS: EBL (P < 0.001), change in mental status (P = 0.001). Baseline cervical malalignment, levels fused, and osteotomy predicted both increased op-time and LOS. These results can be used to better optimize patient care, hospital efficiency, and resource allocation.
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Affiliation(s)
- Samantha R Horn
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Peter G Passias
- Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY, USA.
| | - Cole A Bortz
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Katherine E Pierce
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Avery E Brown
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Haddy Alas
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton Line
- Rocky Mountain Scoliosis and Spine, Denver, CO, USA
| | - Vedat Deviren
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California, Davis, Davis, CA, USA
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robert A Hart
- Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, CO, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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- Rocky Mountain Scoliosis and Spine, Denver, CO, USA
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30
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Passias PG, Segreto FA, Lafage R, Lafage V, Smith JS, Line BG, Scheer JK, Mundis GM, Hamilton DK, Kim HJ, Horn SR, Bortz CA, Diebo BG, Vira S, Gupta MC, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Shaffrey CI, Ames CP, Bess S. Recovery kinetics following spinal deformity correction: a comparison of isolated cervical, thoracolumbar, and combined deformity morphometries. Spine J 2019; 19:1422-1433. [PMID: 30930292 DOI: 10.1016/j.spinee.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The postoperative recovery patterns of cervical deformity patients, thoracolumbar deformity patients, and patients with combined cervical and thoracolumbar deformities, all relative to one another, is not well understood. Clear objective benchmarks are needed to quantitatively define a "good" versus a "bad" postoperative recovery across multiple follow-up visits, varying deformity types, and guide expectations. PURPOSE To objectively define and compare the complete 2-year postoperative recovery process among operative cervical only, thoracolumbar only, and combined deformity patients using area-under-the-curve (AUC) methodology. STUDY DESIGN/SETTING Retrospective review of 2 prospective, multicenter adult cervical and spinal deformity databases. PATIENT SAMPLE One hundred seventy spinal deformity patients. OUTCOME MEASURES Common health-related quality of life (HRQOL) assessments across both databases included the EuroQol 5-Dimension Questionnaire and Numeric Rating Scale (NRS) back pain assessment. In order to compare disability improvements, the Neck Disability Index (NDI) and the Oswestry Disability Index (ODI) were merged into one outcome variable, the ODI-NDI. Both assessments are gauged on the same scale, with minimal question deviation. Sagittal Radiographic Alignment was also assessed at pre- and all postoperative time points. METHODS Operative deformity patients >18 years old with baseline (BL) to 2-year HRQOLs were included. Patients were stratified by cervical only (C), thoracolumbar only (T), and combined deformities (CT). HRQOL and radiographic outcomes were compared within and between deformity groups. AUC normalization generated normalized HRQOL scores at BL and all follow-up intervals (6 weeks, 3 months, 1 year, and 2 year). Normalized scores were plotted against follow-up time interval. AUC was calculated for each follow-up interval, and total area was divided by cumulative follow-up length, determining overall, time-adjusted HRQOL recovery (Integrated Health State, IHS). Multiple linear regression models determined significant predictors of HRQOL discrepancies among deformity groups. RESULTS One hundred seventy patients were included (27 C, 27 T, and 116 CT). Age, BMI, sex, smoking status, osteoporosis, depression, and BL HRQOL scores were similar among groups (p >. 05). T and CT patients had higher comorbidity severities (CCI: C 0.696, T 1.815, CT 1.699, p = .020). Posterior surgical approaches were most common (62.9%) followed by combined (28.8%) and anterior (6.5%). Standard HRQOL analysis found no significant differences among groups until 1-year follow-up, where C patients exhibited comparatively greater NRS back pain (4.88 vs. 3.65 vs. 3.28, p = .028). NRS Back pain differences between groups subsided by 2-years (p>.05). Despite C patients exhibiting significantly faster ODI-NDI minimal clinically important difference (MCID) achievement (33.3% vs. 0% vs. 23.0%, p < .001), all deformity groups exhibited similar ODI-NDI MCID achievement by 2-years (51.9% vs. 59.3% vs. 62.9%, p = 0.563). After HRQOL normalization, similar results were observed relative to the standard analysis (1-year NRS Back: C 1.17 vs. T 0.50 vs. CT 0.51, p < .001; 2-year NRS Back: 1.20 vs. 0.51 vs. 0.69, p = .060). C patients exhibited a worse NRS back normalized IHS (C 1.18 vs. T 0.58 vs. CT 0.63, p = .004), indicating C patients were in a greater state of postoperative back pain for a longer amount of time. Linear regression models determined postoperative distal junctional kyphosis (adjusted beta: 0.207, p = .039) and osteoporosis (adjusted beta: 0.269, p = .007) as the strongest predictors of a poor NRS back IHS (model summary: R2 = 0.177, p = .039). CONCLUSIONS Despite C patients exhibiting a quicker rate of MCID disability (ODI-NDI) improvement, they exhibited a poorer overall recovery of back pain with worse NRS back scores compared with BL status and other deformity groups. Postoperative distal junctional kyphosis and osteoporosis were identified as primary drivers of a poor postoperative NRS back IHS. Utilization of the IHS, a single number adjusting for all postoperative HRQOL visits, in conjunction with predictive modelling may pose as an improved method of gauging the effect of surgical details and complications on a patient's entire recovery process.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA.
| | - Frank A Segreto
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton G Line
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Justin K Scheer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Gregory M Mundis
- Department of Orthopaedics, San Diego Center for Spinal Disorders, La Jolla, CA, USA
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Shaleen Vira
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robert A Hart
- Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
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Horn SR, Bortz CA, Ramachandran S, Poorman GW, Segreto F, Siow M, Sure A, Vasquez-Montes D, Diebo B, Tishelman J, Moon J, Zhou P, Beaubrun B, Vira S, Jalai C, Wang C, Shenoy K, Behery O, Errico T, Lafage V, Buckland A, Passias PG. Suboptimal Age-Adjusted Lumbo-Pelvic Mismatch Predicts Negative Cervical-Thoracic Compensation in Obese Patients. Int J Spine Surg 2019; 13:252-261. [PMID: 31328089 DOI: 10.14444/6034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Given the paucity of literature regarding compensatory mechanisms used by obese patients with sagittal malalignment, it is necessary to gain a better understanding of the effects of obesity on compensation after comparing the degree of malalignment to age-adjusted ideals. This study aims to compare baseline alignment of obese and nonobese patients using age-adjusted spino-pelvic alignment parameters, describing associated spinal changes. Methods Patients ≥ 18 years with full-body stereoradiographs were propensity-score matched for sex, baseline pelvic incidence (PI), and categorized as nonobese (body mass index < 30kg/m2) or obese (body mass index ≥ 30). Age-adjusted ideals were calculated for sagittal vertical axis, spino-pelvic mismatch (PI-LL), pelvic tilt, and T1 pelvic angle using established formulas. Patients were stratified as meeting alignment ideals, being above ideal, or being below. Spinal alignment parameters included C0-C2, C2-C7, C2-T3, cervical thoracic pelvic angle, cervical sagittal vertical axis SVA, thoracic kyphosis, T1 pelvic angle, T1 slope, sagittal vertical axis, lumbar lordosis (LL), PI, PI-LL, pelvic tilt. Lower-extremity parameters included sacrofemoral angle, knee flexion (KA), ankle flexion (AA), pelvic shift (PS), and global sagittal angle (GSA). Independent t tests compared parameters between cohorts. Results Included: 800 obese, 800 nonobese patients. Both groups recruited lower-extremity compensation: sacrofemoral angle (P = .004), KA, AA, PS, GSA (all P < .001). Obese patients meeting age-adjusted PI-LL had greater lower-extremity compensation than nonobese patients: lower sacrofemoral angle (P = .002), higher KA (P = .008), PS (P = .002), and GSA (P = .02). Obese patients with PI-LL mismatch higher than age-adjusted ideal recruited greater lower-extremity compensation than nonobese patients: higher KA, AA, PS, GSA (all P < .001). Obese patients showed compensation through the cervical spine: increased C0-C2, C2-C7, C2-T3, and cervical sagittal vertical axis (all P < .001), high T1 pelvic angle (P < .001), cervical thoracic pelvic angle (P = .03), and T1 slope (P < .001), with increased thoracic kyphosis (P = .015) and decreased LL (P < .001) compared to nonobese patients with PI-LL larger than age-adjusted ideal. Conclusions Regardless of malalignment severity, obese patients recruited lower-limb compensation more than nonobese patients. Obese patients with PI-LL mismatch larger than age-adjusted ideal also develop upper-cervical and cervicothoracic compensation for malalignment. Level of Evidence III. Clinical Relevance Clinical evaluation should extend to the cervical spine in obese patients not meeting age-adjusted sagittal alignment ideals.
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Affiliation(s)
- Samantha R Horn
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Cole A Bortz
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | | | - Gregory W Poorman
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Frank Segreto
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Matt Siow
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Akhila Sure
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | | | - Bassel Diebo
- Deparment of Orthopedic Surgery, SUNY Downstate, New York, New York
| | - Jared Tishelman
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - John Moon
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Peter Zhou
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Bryan Beaubrun
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Shaleen Vira
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Cyrus Jalai
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Charles Wang
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Kartik Shenoy
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Omar Behery
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Thomas Errico
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Virginie Lafage
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York
| | - Aaron Buckland
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
| | - Peter G Passias
- Department of Orthopaedics. NYU Langone Orthopaedic Hospital, New York, New York
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Segreto FA, Passias PG, Lafage R, Lafage V, Smith JS, Line BG, Mundis GM, Bortz CA, Stekas ND, Horn SR, Diebo BG, Brown AE, Ihejirika Y, Nunley PD, Daniels AH, Gupta MC, Gum JL, Hamilton DK, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Incidence of Acute, Progressive, and Delayed Proximal Junctional Kyphosis Over an 8-Year Period in Adult Spinal Deformity Patients. Oper Neurosurg (Hagerstown) 2019; 18:75-82. [DOI: 10.1093/ons/opz128] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/09/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up.
OBJECTIVE
To assess the incidence of PJK utilizing a high-powered ASD database.
METHODS
Retrospective review of a prospective multicenter ASD database. Operative ASD patients > 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development.
RESULTS
A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P < .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P < .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594).
CONCLUSION
Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.
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Affiliation(s)
- Frank A Segreto
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Peter G Passias
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Breton G Line
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Gregory M Mundis
- Department of Orthopedics, San Diego Center for Spinal Disorders, La Jolla, California
| | - Cole A Bortz
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Nicholas D Stekas
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Samantha R Horn
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Bassel G Diebo
- Department of Orthopedic Surgery, State University of New York Downstate Medical Center, Brooklyn, New York, New York
| | - Avery E Brown
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Yael Ihejirika
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | | | - Alan H Daniels
- Department of Orthopedics, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Munish C Gupta
- Department of Orthopedic Surgery, University of California, Davis, Davis, California
| | - Jeffrey L Gum
- Norton Leatherman Spine Center, Louisville, Kentucky
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburg School of Medicine, Pittsburgh, Pennsylvania
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California, Davis, Davis, California
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A Hart
- Department of Orthopedics, Swedish Neuroscience Institute, Seattle, Washington
| | - Frank J Schwab
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Chan HYH, Segreto FA, Horn SR, Bortz C, Choy GG, Passias PG, Deverall HH, Baker JF. C2 Fractures in the Elderly: Single-Center Evaluation of Risk Factors for Mortality. Asian Spine J 2019. [DOI: 10.31616/asj.20.18.0300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chan HYH, Segreto FA, Horn SR, Bortz C, Choy GG, Passias PG, Deverall HH, Baker JF. C2 Fractures in the Elderly: Single-Center Evaluation of Risk Factors for Mortality. Asian Spine J 2019; 13:746-752. [PMID: 31079430 PMCID: PMC6773992 DOI: 10.31616/asj.2018.0300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022] Open
Abstract
Study Design Retrospective cohort study. Purpose The aim of this study was to identify features associated with increased mortality risk in traumatic C2 fractures in the elderly, including measures of comorbidity and frailty. Overview of Literature C2 fractures in the elderly are of increasing relevance in the setting of an aging global population and have a high mortality rate. Previous analyzes of risk factors for mortality have not included the measures of comorbidity and/or frailty, and no local data have been reported to date. Methods This study comprises a retrospective review of 70 patients of age >65 years at Waikato Hospital, New Zealand with traumatic C2 fractures identified on computed tomography between 2010 and 2016. Demographic details, medical history, laboratory results on admission, mechanism of injury, and neurological status on presentation were recorded. Medical comorbidities were also detailed allowing calculation of the Charlson Comorbidity Index (CCI) and the modified Frailty Index (mFI). Results The most common mechanism of injury was a fall from standing height (n=52, 74.3%). Mortality rates were 14.3% (n=10) at day 30, and 35.7% (n=25) at 1 year. Bivariate analysis showed that both CCI and mFI correlated with 1-year mortality rates. Reduced albumin and hemoglobin levels were also associated with 30-day and 1-year mortality rates. Forward stepwise logistic regression models determined CCI and low hemoglobin as predictors of mortality within 30 days, whereas CCI, low albumin, increased age, and female gender predicted mortality at 1 year. Conclusions The CCI was a useful tool for predicting mortality at 1 year in the patient cohort. Other variables, including common laboratory markers, can also be used for risk stratification, to initiate timely multidisciplinary management, and prognostic counseling for patients and family members.
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Affiliation(s)
- Hoi-Ying H Chan
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Frank A Segreto
- Department of Orthopaedic and Neurological Surgery, NYU Langone Medical Centre-Orthopaedic Hospital, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic and Neurological Surgery, NYU Langone Medical Centre-Orthopaedic Hospital, New York, NY, USA
| | - Cole Bortz
- Department of Orthopaedic and Neurological Surgery, NYU Langone Medical Centre-Orthopaedic Hospital, New York, NY, USA
| | - Godwin G Choy
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Peter G Passias
- Department of Orthopaedic and Neurological Surgery, NYU Langone Medical Centre-Orthopaedic Hospital, New York, NY, USA
| | - Hamish H Deverall
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand.,Department of Surgery, University of Auckland, Auckland, New Zealand
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Passias PG, Jalai CM, Diebo BG, Cruz DL, Poorman GW, Buckland AJ, Day LM, Horn SR, Liabaud B, Lafage R, Soroceanu A, Baker JF, McClelland S, Oren JH, Errico TJ, Schwab FJ, Lafage V. Full-Body Radiographic Analysis of Postoperative Deviations From Age-Adjusted Alignment Goals in Adult Spinal Deformity Correction and Related Compensatory Recruitment. Int J Spine Surg 2019; 13:205-214. [PMID: 31131222 DOI: 10.14444/6028] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Full-body stereographs for adult spinal deformity (ASD) have enhanced global deformity and lower-limb compensation associations. The advent of age-adjusted goals for classic ASD parameters (sagittal vertical axis, pelvic tilt, spino-pelvic mismatch [PI-LL]) has enabled individualized evaluation of successful versus failed realignment, though these remain to be radiographically assessed postoperatively. This study analyzes pre- and postoperative sagittal alignment to quantify patient-specific correction against age-adjusted goals, and presents differences in compensation in patients whose postoperative profile deviates from targets. Methods Single-center retrospective review of ASD patients ≥ 18 years with biplanar full-body stereographic x-rays. Inclusion: ≥ 4 levels fused, complete baseline and early (≤ 6-month) follow-up imaging. Correction groups generated at postoperative visit for actual alignment compared to age-adjusted ideal values for pelvic tilt, PI-LL, and sagittal vertical axis derived from clinically relevant formulas. Patients that matched exact ± 10-year threshold for age-adjusted targets were compared to unmatched cases (undercorrected or overcorrected). Comparison of spinal alignment and compensatory mechanisms (thoracic kyphosis, hip extension, knee flexion, ankle flexion, pelvic shift) across correction groups were performed with ANOVA and paired t tests. Results The sagittal vertical axis, pelvic tilt, and PI-LL of 122 patients improved at early postoperative visits (P < .001). Of lower-extremity parameters, knee flexion and pelvic shift improved (P < .001), but hip extension and ankle flexion were similar (P > .170); global sagittal angle decreased overall, reflecting global postoperative correction (8.3° versus 4.4°, P < .001). Rates of undercorrection to age-adjusted targets for each spino-pelvic parameter were 30.3% (sagittal vertical axis), 41.0% (pelvic tilt), and 43.6% (PI-LL). Compared to matched/overcorrections, undercorrections recruited increased posterior pelvic shift to compensate (P < .001); knee flexion was recruited in undercorrections for sagittal vertical axis and pelvic tilt; thoracic hypokyphosis was observed in PI-LL undercorrections. All undercorrected groups displayed consequentially larger global sagittal angle (P < .001). Conclusions Global alignment cohort improvements were observed, and when comparing actual to age-adjusted alignment, undercorrections recruited pelvic and lower-limb flexion to compensate. Level of Evidence 3.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Dana L Cruz
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Gregory W Poorman
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Aaron J Buckland
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Louis M Day
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Samantha R Horn
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Barthélemy Liabaud
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Alexandra Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Joseph F Baker
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Shearwood McClelland
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Jonathan H Oren
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Thomas J Errico
- Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Bortz CA, Passias PG, Segreto F, Horn SR, Lafage V, Smith JS, Line B, Mundis GM, Kebaish KM, Kelly MP, Protopsaltis T, Sciubba DM, Soroceanu A, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Indicators for Nonroutine Discharge Following Cervical Deformity-Corrective Surgery: Radiographic, Surgical, and Patient-Related Factors. Neurosurgery 2019; 85:E509-E519. [DOI: 10.1093/neuros/nyz016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 01/29/2019] [Indexed: 11/14/2022] Open
Abstract
AbstractBACKGROUNDNonroutine discharge, including discharge to inpatient rehab and skilled nursing facilities, is associated with increased cost-of-care. Given the rising prevalence of cervical deformity (CD)-corrective surgery and the necessity of value-based healthcare, it is important to identify indicators for nonroutine discharge.OBJECTIVETo identify factors associated with nonroutine discharge after CD-corrective surgery using a statistical learning algorithm.METHODSA retrospective review of patients ≥18 yr with discharge and baseline (BL) radiographic data. Conditional inference decision trees identified factors associated with nonroutine discharge and cut-off points at which factors were significantly associated with discharge status. A conditional variable importance table used nonreplacement sampling set of 10 000 conditional inference trees to identify influential patient/surgical factors. The binary logistic regression indicated odds of nonroutine discharge for patients with influential factors at significant cut-off points.RESULTSOf 138 patients (61 yr, 63% female) undergoing surgery for CD (8 ± 5 levels; 49% posterior approach, 16% anterior, and 35% combined), 29% experienced nonroutine discharge. BL cervical/upper-cervical malalignment showed the strongest relationship with nonroutine discharge: C1 slope ≥ 14°, C2 slope ≥ 57°, TS-CL ≥ 57°. Patient-related factors associated with nonroutine discharge included BL gait impairment, age ≥ 59 yr and apex of CD primary driver ≥ C7. The only surgical factor associated with nonroutine discharge was fusion ≥ 8 levels. There was no relationship between nonhome discharge and reoperation within 6 mo or 1 yr (both P > .05) of index procedure. Despite no differences in BL EQ-5D (P = .946), nonroutine discharge patients had inferior 1-yr postoperative EQ-5D scores (P = .044).CONCLUSIONSevere preoperative cervical malalignment was strongly associated with nonroutine discharge following CD-corrective surgery. Age, deformity driver, and ≥ 8 level fusions were also associated with nonroutine discharge and should be taken into account to improve patient counseling and health care resource allocation.
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Affiliation(s)
- Cole A Bortz
- Department of Orthopedics, NYU Langone Orthopedic Hospital New York, New York
| | - Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital New York, New York
| | - Frank Segreto
- Department of Orthopedics, NYU Langone Orthopedic Hospital New York, New York
| | - Samantha R Horn
- Department of Orthopedics, NYU Langone Orthopedic Hospital New York, New York
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Breton Line
- International Spine Study Group, Denver, Colorado
| | | | - Khaled M Kebaish
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri
| | | | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexandra Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California, Davis, California
| | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Frank J Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, Colorado
| | | | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, California
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Passias PG, Bortz CA, Pierce KE, Segreto FA, Horn SR, Vasquez-Montes D, Lafage V, Brown AE, Ihejirika Y, Alas H, Varlotta C, Ge DH, Shepard N, Oh C, DelSole EM, Jankowski PP, Hockley A, Diebo BG, Vira SN, Sciubba DM, Raad M, Neuman BJ, Gerling MC. Decreased rates of 30-day perioperative complications following ASD-corrective surgery: A modified Clavien analysis of 3300 patients from 2010 to 2014. J Clin Neurosci 2019; 61:147-152. [DOI: 10.1016/j.jocn.2018.10.104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/28/2018] [Indexed: 11/24/2022]
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Poorman GW, Segreto FA, Beaubrun BM, Jalai CM, Horn SR, Bortz CA, Diebo BG, Vira S, Bono OJ, DE LA Garza-Ramos R, Moon JY, Wang C, Hirsch BP, Tishelman JC, Zhou PL, Gerling M, Passias PG. Traumatic Fracture of the Pediatric Cervical Spine: Etiology, Epidemiology, Concurrent Injuries, and an Analysis of Perioperative Outcomes Using the Kids' Inpatient Database. Int J Spine Surg 2019; 13:68-78. [PMID: 30805288 DOI: 10.14444/6009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The study aimed to characterize trends in incidence, etiology, fracture types, surgical procedures, complications, and concurrent injuries associated with traumatic pediatric cervical fracture using a nationwide database. Methods The Kids' Inpatient Database (KID) was queried. Trauma cases from 2003 to 2012 were identified, and cervical fracture patients were isolated. Demographics, etiologies, fracture levels, procedures, complications, and concurrent injuries were assessed. The t-tests elucidated significance for continuous variables, and χ2 for categoric values. Logistic regressions identified predictors of spinal cord injury (SCI), surgery, any complication, and mortality. Level of significance was P < .05. Results A total of 11 196 fracture patients were isolated (age, 16.63 years; male, 65.7%; white, 65.4%; adolescent, 55.4%). Incidence significantly increased since 2003 (2003 vs 2012, 2.39% vs 3.12%, respectively), as did Charlson Comorbidity Index (CCI; 2003 vs 2012, 0.2012 vs 0.4408, respectively). Most common etiology was motor vehicle accidents (50.5%). Infants and children frequently fractured at C2 (closed: 43.1%, 32.9%); adolescents and young adults frequently fractured at C7 (closed: 23.9%, 26.5%). Upper cervical SCI was less common (5.8%) than lower cervical SCI (10.9%). Lower cervical unspecified-SCI, anterior cord syndrome, and other specified SCIs significantly decreased since 2003. Complications were common (acute respiratory distress syndrome, 7.8%; anemia, 6.7%; shock, 3.0%; and mortality, 4.2%), with bowel complications, cauda equina, anemia, and shock rates significantly increasing since 2003. Concurrent injuries were common (15.2% ribs; 14.4% skull; 7.1% pelvis) and have significantly increased since 2003. Predictors of SCI included sports injury and CCI. Predictors of surgery included falls, sports injuries, CCI, length of stay, and SCI. CCI, SCIs, and concurrent injuries were predictors of any complication and mortality, all (P < .001). Conclusions Since 2003, incidence, complications, concurrent injuries, and fusions have increased. CCI, SCI, falls, and sports injuries were significant predictors of surgical intervention. Decreased mortality and SCI rates may indicate improving emergency medical services and management guidelines. Level of Evidence III. Clinical Relevance Clinicians should be aware of increased case complexity in the onset of added perioperative complications and concurrent injuries. Cervical fractures resultant of sports injuries should be scrutinized for concurrent SCIs.
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Affiliation(s)
- Gregory W Poorman
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Frank A Segreto
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Bryan M Beaubrun
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Cyrus M Jalai
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Samantha R Horn
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Cole A Bortz
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Shaleen Vira
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Olivia J Bono
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | | | - John Y Moon
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Charles Wang
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Brandon P Hirsch
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Jared C Tishelman
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Peter L Zhou
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Michael Gerling
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
| | - Peter G Passias
- Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, Hospital for Joint Diseases at NYU Langone Medical Center, NYU School of Medicine, New York, New York
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Passias PG, Poorman GW, Horn SR, Jalai CM, Bortz C, Segreto F, Diebo BM, Daniels A, Hamilton DK, Sciubba D, Smith J, Neuman B, Shaffrey CI, LaFage V, LaFage R, Schwab F, Bess S, Ames C, Hart R, Soroceanu A, Mundis G, Eastlack R. Effect of Obesity on Radiographic Alignment and Short-Term Complications After Surgical Treatment of Adult Cervical Deformity. World Neurosurg 2019; 125:e1082-e1088. [PMID: 30790725 DOI: 10.1016/j.wneu.2019.01.248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 01/23/2019] [Accepted: 01/24/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We investigated the 30-day complication incidence and 1-year radiographic correction in obese patients undergoing surgical treatment of cervical deformity. METHODS The patients were stratified according to World Health Organization's definition for obesity: obese, patients with a body mass index of ≥30 kg/m2; and nonobese, patients with a body mass index of <30 kg/m2. The patients had undergone surgery for the treatment of cervical deformity. The patient baseline demographic, comorbidity, and radiographic data were compared between the 2 groups at baseline and 1 year postoperatively. The 30-day complication incidence was stratified according to complication severity (any, major, or minor), and type (cardiopulmonary, dysphagia, infection, neurological, and operative). Binary logistic regression models were used to assess the effect of obesity on developing those complications, with adjustment for patient age and levels fused. RESULTS A total of 124 patients were included, 53 obese and 71 nonobese patients. The 2 groups had a similar T1 slope minus cervical lordosis (obese, 37.2° vs. nonobese, 36.9°; P = 0.932) and a similar C2-C7 (-5.9° vs. -7.3°; P = 0.718) and C2-C7 (50.1 mm vs. 44.1 mm; P = 0.184) sagittal vertical axis. At the 1-year follow-up examination, the T1 pelvic angle (1.0° vs. -3.1°; P = 0.021) and C2-S1 sagittal vertical axis (-5.9 mm vs. -35.0 mm; P = 0.036) were different, and the T1 spinopelvic inclination (-1.0° vs. -2.9°; P = 0.123) was similar. The obese patients had a greater risk of overall short-term complications (odds ratio, 2.5; 95% confidence interval, 1.1-6.1) and infectious complications (odds ratio, 5.0; 95% confidence interval, 1.0-25.6). CONCLUSIONS Obese patients had a 5 times greater odds of developing infections after surgery for adult cervical deformity. Obese patients also showed significantly greater pelvic anteversion after cervical correction.
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Affiliation(s)
- Peter G Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA.
| | - Gregory W Poorman
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Samantha R Horn
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Cyrus M Jalai
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Cole Bortz
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Frank Segreto
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA
| | - Bassel M Diebo
- Deparment of Orthopedic Surgery, SUNY Downstate Medical School, Brooklyn, New York, USA
| | - Alan Daniels
- Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Justin Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Brian Neuman
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Virginie LaFage
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Renaud LaFage
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, Colorado, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Robert Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington, USA
| | - Alexandra Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Gregory Mundis
- San Diego Center for Spinal Disorders, La Jolla, California, USA
| | - Robert Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA
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Segreto FA, Vasquez-Montes D, Bortz CA, Horn SR, Diebo BG, Vira S, Kelly JJ, Stekas N, Ge DH, Ihejirika YU, Lafage R, Lafage V, Karamitopoulos M, Delsole EM, Hockley A, Petrizzo AM, Buckland AJ, Errico TJ, Gerling MC, Passias PG. Impact of presenting patient characteristics on surgical complications and morbidity in early onset scoliosis. J Clin Neurosci 2019; 62:105-111. [PMID: 30635164 DOI: 10.1016/j.jocn.2018.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
This study sought to assess comorbidity profiles unique to early-onset-scoliosis (EOS) patients by employing cluster analytics and to determine the influence of isolated comorbidity clusters on perioperative complications, morbidity and mortality using a high powered administrative database. The KID database was queried for ICD-9 codes pertaining to congenital and idiopathic scoliosis from 2003, 2006, 2009, 2012. Patients <10 y/o (EOS group) were included. Demographics, incidence and comorbidity profiles were assessed. Comorbidity profiles were stratified by body systems (neurological, musculoskeletal, pulmonary, cardiovascular, renal). K-means cluster and descriptive analyses elucidated incidence and comorbidity relationships between frequently co-occurring comorbidities. Binary logistic regression models determined predictors of perioperative complication development, mortality, and extended length-of-stay (≥75th percentile). 25,747 patients were included (Age: 4.34, Female: 52.1%, CCI: 0.64). Incidence was 8.9 per 100,000 annual discharges. 55.2% presented with pulmonary comorbidities, 48.7% musculoskeletal, 43.8% neurological, 18.6% cardiovascular, and 11.9% renal; 38% had concurrent neurological and pulmonary. Top inter-bodysystem clusters: Pulmonary disease (17.2%) with epilepsy (17.8%), pulmonary failure (12.2%), restrictive lung disease (10.5%), or microcephaly and quadriplegia (2.1%). Musculoskeletal comorbidities (48.7%) with renal and cardiovascular comorbidities (8.2%, OR: 7.9 [6.6-9.4], p < 0.001). Top intra-bodysystem clusters: Epilepsy (11.7%) with quadriplegia (25.8%) or microcephaly (20.5%). Regression analysis determined neurological and pulmonary clusters to have a higher odds of perioperative complication development (OR: 1.28 [1.19-1.37], p < 0.001) and mortality (OR: 2.05 [1.65-2.54], p < 0.001). Musculoskeletal with cardiovascular and renal anomalies had higher odds of mortality (OR: 1.72 [1.28-2.29], p < 0.001) and extLOS (OR: 2.83 [2.48-3.22], p < 0.001). EOS patients with musculoskeletal conditions were 7.9x more likely to have concurrent cardiovascular and renal anomalies. Clustered neurologic and pulmonary anomalies increased mortality risk by as much as 105%. These relationships may benefit pre-operative risk assessment for concurrent anomalies and adverse outcomes. Level of Evidence: III - Retrospective Prognostic Study.
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Affiliation(s)
- Frank A Segreto
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Dennis Vasquez-Montes
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Shaleen Vira
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - John J Kelly
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Nicholas Stekas
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - David H Ge
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Yael U Ihejirika
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Mara Karamitopoulos
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Edward M Delsole
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Aaron Hockley
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Anthony M Petrizzo
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Aaron J Buckland
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Thomas J Errico
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Michael C Gerling
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Peter G Passias
- Department of Orthopaedics. NYU Medical Center-Orthopaedic Hospital, New York, NY, USA.
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Passias PG, Horn SR, Raman T, Brown AE, Lafage V, Lafage R, Smith JS, Bortz CA, Segreto FA, Pierce KE, Alas H, Line BG, Diebo BG, Daniels AH, Kim HJ, Soroceanu A, Mundis GM, Protopsaltis TS, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery. J Craniovertebr Junction Spine 2019; 10:160-166. [PMID: 31772428 PMCID: PMC6868539 DOI: 10.4103/jcvjs.jcvjs_53_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Correction of cervical deformity (CD) often involves different types of osteotomies to address sagittal malalignment. This study assessed the relationship between osteotomy grade and vertebral level on alignment and clinical outcomes. Methods: Retrospective review of a multi-center prospectively collected CD database. CD was defined as at least one of the following: C2–C7 Cobb >10°, cervical lordosis (CL) >10°, C2–C7 sagittal vertical axis (cSVA) >4 cm, and chin-brow vertical angle > 25°. Patients were evaluated for level and type of cervical osteotomy. Results: 86 CD patients were included (61.4 ± 10.6 years, 66.3% female, body mass index 29.1 kg/m2). 141 osteotomies were in the cervical spine and 79 were in the thoracic spine. There were 19 major osteotomies performed, with 47% at T1. Patients with an osteotomy in the cervical spine improved in T1 slope minus CL (TS − CL), CL, and C2 slope (all P < 0.05). Patients with upper thoracic osteotomies improved in TS − CL, cSVA, C2–T3, C2–T3 sagittal vertical axis (SVA), and C2 slope (all P < 0.05). Minor osteotomies in the upper thoracic spine showed improvement in cSVA (63 mm to 49 mm, P = 0.022), C2–T3 (P = 0.007), and SVA (−16 mm to 27 mm, P < 0.001). The greatest amount of C2–T3 angular change occurred for patients with a major osteotomy at T2 (39.1° change), then T3 (15.7°), C7 (16.9°°), and T1 (13.5°°). Patients with a major osteotomy in the upper thoracic spine showed similar radiographic changes from pre- to post-operative as patients with three or more minor osteotomies, although C2–T3 SVA trended toward greater improvement with a major osteotomy (−22.5 mm vs. +5.9 mm, P = 0.058) due to lever arm effect. Conclusions: CD patients undergoing osteotomies in the cervical and upper thoracic spine experienced improvement in TS–−CL and C2 slope. In the upper thoracic spine, multiple minor osteotomies achieved similar alignment changes to major osteotomies at a single level, while a major osteotomy focused at T2 had the greatest overall impact in cervicothoracic and global alignment in CD patients.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Tina Raman
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Avery E Brown
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Cole A Bortz
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Frank A Segreto
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Haddy Alas
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Breton G Line
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate, New York, NY, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Alex Soroceanu
- Department of Orthopaedic Surgery, University of Calgary, Calgary, AB, Canada
| | | | - Themistocles S Protopsaltis
- Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, New York Spine Institute, New York, NY, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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Passias PG, Oh C, Horn SR, Kim HJ, Hamilton DK, Sciubba DM, Neuman BJ, Buckland AJ, Poorman GW, Segreto FA, Bortz CA, Brown AE, Protopsaltis TS, Klineberg EO, Ames C, Smith JS, Lafage V. Predicting the occurrence of complications following corrective cervical deformity surgery: Analysis of a prospective multicenter database using predictive analytics. J Clin Neurosci 2019; 59:155-161. [DOI: 10.1016/j.jocn.2018.10.111] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/27/2018] [Indexed: 11/29/2022]
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Zhou PL, Poorman GW, Wang C, Pierce KE, Bortz CA, Alas H, Brown AE, Tishelman JC, Janjua MB, Vasquez-Montes D, Moon J, Horn SR, Segreto F, Ihejirika YU, Diebo BG, Passias PG. Klippel-Feil: A constellation of diagnoses, a contemporary presentation, and recent national trends. J Craniovertebr Junction Spine 2019; 10:133-138. [PMID: 31772424 PMCID: PMC6868534 DOI: 10.4103/jcvjs.jcvjs_65_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Klippel–Feil syndrome (KFS) includes craniocervical anomalies, low posterior hairline, and brevicollis, with limited cervical range of motion; however, there remains no consensus on inheritance pattern. This study defines incidence, characterizes concurrent diagnoses, and examines trends in the presentation and management of KFS. Methods: This was a retrospective review of the Kid's Inpatient Database (KID) for KFSpatients aged 0–20 years from 2003 to 2012. Incidence was established using KID-supplied year and hospital-trend weights. Demographics and secondary diagnoses associated with KFS were evaluated. Comorbidities, anomalies, and procedure type trends from 2003 to 2012 were assessed for likelihood to increase among the years studied using ANOVA tests. Results: Eight hundred and fifty-eight KFS diagnoses (age: 9.49 years; 51.1% females) and 475 patients with congenital fusion (CF) (age: 8.33 years; 50.3% females) were analyzed. We identified an incidence rate of 1/21,587 discharges. Only 6.36% of KFS patients were diagnosed with Sprengel's deformity; 1.44% with congenital fusion. About 19.1% of KFS patients presented with another spinal abnormality and 34.0% presented with another neuromuscular anomaly. About 36.51% of KFS patients were diagnosed with a nonspinal or nonmusculoskeletal anomaly, with the most prevalent anomalies being of cardiac origin (12.95%). About 7.34% of KFS patients underwent anterior fusions, whereas 6.64% of KFS patients underwent posterior fusions. The average number of levels operated on was 4.99 with 8.28% receiving decompressions. Interbody devices were used in 2.45% of cases. The rate of fusions with <3 levels (7.46%) was comparable to that of 3 levels or greater (7.81%). Conclusions: KFS patients were more likely to have other spinal abnormalities (19.1%) and nonnervous system abnormalities (13.63%). Compared to congenital fusions, KFS patients were more likely to have congenital abnormalities such as Sprengel's deformity. KFS patients are increasingly being treated with spinal fusion. Level of Evidence: III
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Affiliation(s)
- Peter L Zhou
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Gregory W Poorman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Charles Wang
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Katherine E Pierce
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Haddy Alas
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Avery E Brown
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Jared C Tishelman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | | | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - John Moon
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Frank Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Yael U Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Suny Downstate Medical Center, Brooklyn, NY, USA
| | - Peter Gust Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
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Segreto FA, Beyer GA, Grieco P, Horn SR, Bortz CA, Jalai CM, Passias PG, Paulino CB, Diebo BG. Vertebral Osteomyelitis: A Comparison of Associated Outcomes in Early Versus Delayed Surgical Treatment. Int J Spine Surg 2018; 12:703-712. [PMID: 30619674 DOI: 10.14444/5088] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background The recommended timing of surgical intervention for vertebral osteomyelitis (VO) is controversial; however, most studies are not sufficiently powered. Our goal was to investigate the associated effects of delaying surgery in VO patients on in-hospital complications, neurologic deficits, and mortality. Methods Retrospective review of the National Inpatient Sample. Patients who underwent surgery for VO from 1998 to 2013 were identified using codes from the International Classification of Disease, Ninth Revision, Clinical Modification. Patients were stratified into groups based on incremental delay of surgery: 0-day delay (same-day surgery), 1-day delay, 2-day delay, 3- to 6-day delay, 7- to 14-day delay, and 14- to 30-day delay. Univariate analysis compared demographics and outcomes between groups. Multivariate logistic regression models calculated independent predictors of any complication, mortality, and neurologic deficits. A 0-day delay was the reference group. Results A total of 34 465 patients were identified. Delayed groups were older (same day: 53.5 vs. 7-14-day delay: 61.1) and had a higher Deyo-Charlson score (same day: 0.4901 vs. 14-30-day delay: 1.66), length of stay (same day: 4.2 vs. 14-30-day delay: 34.04 days), and total charges (same day: $63,390.78 vs. 14-30-day delay: $245,752.4), all P < .001. Delayed groups had higher surgical combined-approach rates (same day: 9.1% vs. 14-30-day delay: 31.5%) and lower anterior-approach rates (same day: 42.4% vs. 14-30-day delay: 24.2%). Delayed groups had increased mortality and complication rates. Regressions showed delayed groups as the strongest independent indicators of any complication (14-30-day delay: odds ratio [OR] 3.384), mortality (14-30-day delay: OR 10.658), and neurologic deficits (14-30-day delay: OR 3.464), all P < .001. Conclusion VO patients who operate within 24 hours of admission are more likely to have desirable outcomes. Patients with delayed surgery had a significantly increased risk of developing any complication, mortality, and discharging with neurologic deficits. Level of Evidence III. Clinical Relevance Medically fit patients may benefit from earlier surgical management in order to reduce risk of postoperative complications, improve outcomes, and reduce overall hospital costs.
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Affiliation(s)
- Frank A Segreto
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | | | - Preston Grieco
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
| | - Samantha R Horn
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Cole A Bortz
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Cyrus M Jalai
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Peter G Passias
- Department of Orthopaedics, NYU Langone Medical Center, Hospital for Joint Diseases, New York, New York
| | - Carl B Paulino
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate, Brooklyn, New York
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Passias PG, Jalai CM, Worley N, Vira S, Scheer JK, Smith JS, Ramachandran S, Soroceanu A, Horn SR, Poorman GW, Protopsaltis TS, Klineberg EO, Sciubba DM, Kim HJ, Hamilton DK, Lafage R, Lafage V, Ames CP. Development of New-Onset Cervical Deformity in Nonoperative Adult Spinal Deformity Patients With 2-Year Follow-Up. Int J Spine Surg 2018; 12:725-734. [PMID: 30619677 DOI: 10.14444/5091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Evaluate the presence of new-onset cervical deformity (CD) in nonoperative adult spinal deformity (ASD) patients with extended follow-up, with consideration for predictors, prevalence, and impact on patient-reported outcomes. Methods Retrospective review of a prospective nonoperative ASD cohort. New onset CD patients at 1- (CD-1Y) and 2-year (CD-2Y) follow-up were defined as displaying baseline cervical alignment. Univariate analyses determined differences in radiographic parameters and outcome scores of CD and maintained-cervical-alignment patients. Multivariate binary logistic regression models determined new-onset CD predictors. Results A total of 143 patients were included (mean age 54 years, mean body mass index 25.6 kg/m2, 86% female). Cervical deformity rate was 38.5% at baseline. New-onset CD incidence at 1- and 2-year follow-up was 30.0% and 41.7%, respectively. Global sagittal profile comparison of CD-1Y/CD-2Y versus maintained cervical alignment cases revealed no differences (P > .05) at any interval. Baseline C2-C7 sagittal vertical axis (SVA) was associated with increased new-onset CD risk at 1 (odds ratio [OR] 1.14, P = .025) and 2 years (OR 1.04, P = .032); prior spine surgical history was associated with CD risk at 1-year follow-up (OR 6.75, P = .047); baseline C2 slope was associated with increased CD risk at 2-year follow-up (OR 1.12, P = .041). CD development did not significantly impact health-related quality of life (P > .05). Conclusions Cervical deformity can manifest in nonoperative ASD patients: 30.0% at 1-year follow-up, and 41.7% at 2-year follow-up. Progressive CD manifested independently of thoracolumbar profile changes. Increased baseline C2-C7 SVA, C2 slope, and prior surgical history increased new-onset CD odds at 1 and 2 years.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Nancy Worley
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Shaleen Vira
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Justin K Scheer
- School of Medicine, University of California, San Diego, La Jolla, California
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Subaraman Ramachandran
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | | | - Samantha R Horn
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Gregory W Poorman
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | | | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Passias PG, Vasquez-Montes D, Poorman GW, Protopsaltis T, Horn SR, Bortz CA, Segreto F, Diebo B, Ames C, Smith J, LaFage V, LaFage R, Klineberg E, Shaffrey C, Bess S, Schwab F. Predictive model for distal junctional kyphosis after cervical deformity surgery. Spine J 2018; 18:2187-2194. [PMID: 29709551 DOI: 10.1016/j.spinee.2018.04.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 02/14/2018] [Accepted: 04/20/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Distal junctional kyphosis (DJK) is a primary concern of surgeons correcting cervical deformity. Identifying patients and procedures at higher risk of developing this condition is paramount in improving patient selection and care. PURPOSE The present study aimed to develop a risk index for DJK development in the first year after surgery. STUDY DESIGN/SETTING This is a retrospective review of a prospective multicenter cervical deformity database. PATIENT SAMPLE Patients over the age of 18 meeting one of the following deformities were included in the study: cervical kyphosis (C2-7 Cobb angle>10°), cervical scoliosis (coronal Cobb angle>10°), positive cervical sagittal imbalance (C2-C7 sagittal vertical axis (SVA)>4 cm or T1-C6>10°), or horizontal gaze impairment (chin-brow vertical angle>25°). OUTCOME MEASURES Development of DJK at any time before 1 year. METHODS Distal junctional kyphosis was defined by both clinical diagnosis (by enrolling surgeon) and post hoc identification of development of an angle<-10° from the end of fusion construct to the second distal vertebra, as well as a change in this angle by <-10° from baseline. Conditional Inference Decision Trees were used to identify factors predictive of DJK incidence and the cut-off points at which they have an effect. A conditional Variable-Importance table was constructed based on a non-replacement sampling set of 2,000 Conditional Inference Trees. Twelve influencing factors were found; binary logistic regression for each variable at significant cutoffs indicated their effect size. RESULTS Statistical analysis included 101 surgical patients (average age: 60.1 years, 58.3% female, body mass index: 30.2) undergoing long cervical deformity correction (mean levels fused: 7.1, osteotomy used: 49.5%, approach: 46.5% posterior, 17.8% anterior, 35.7% combined). In 2 years after surgery, 6% of patients were diagnosed with clinical DJK; however, 23.8% of patients met radiographic definition for DJK. Patients with neurologic symptoms were at risk of DJK (odds ratio [OR]: 3.71, confidence interval [CI]: 0.11-0.63). However, no significant relationship was found between osteoporosis, age, and ambulatory status with DJK incidence. Baseline radiographic malalignments were the most numerous and strong predictors for DJK: (1) C2-T1 tilt>5.33 (OR: 6.94, CI: 2.99-16.14); (2) kyphosis<-50.6° (OR: 5.89, CI: 0.07-0.43); (3) C2-C7 lordosis<-12° (OR: 5.7, CI: 0.08-0.41); (4) T1 slope minus cervical lordosis>36.4 (OR: 5.6, CI: 2.28-13.57); (5) C2-C7 SVA>56.3° (OR: 5.4, CI: 2.20-13.23); and (6) C4_Tilt>56.7 (OR: 5.0, CI: 1.90-13.1). Clinically, combined approaches (OR: 2.67, CI: 1.21-5.89) and usage of Smith-Petersen osteotomy (OR: 2.55, CI: 1.02-6.34) were the most important predictors of DJK. CONCLUSIONS In a surgical cohort of patients with cervical deformity, we found a 23.8% incidence of DJK. Different procedures and patient malalignment predicted incidence of DJK up to 1 year. Preoperative T1 slope-cervical lordosis, cervical kyphosis, SVA, and cervical lordosis all strongly predicted DJK at specific cut-off points. Knowledge of these factors will potentially help direct future study and strategy aimed at minimizing this potentially dramatic occurrence.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA.
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA
| | - Gregory W Poorman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA
| | - Themistocles Protopsaltis
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA
| | - Frank Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th St, New York, NY, 10003, USA
| | - Bassel Diebo
- Department of Orthopaedic Surgery, SUNY Health Sciences Center at Downstate, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Chris Ames
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94143, USA
| | - Justin Smith
- Department of Neurosurgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA
| | - Virginie LaFage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 350 E 70th St, New York City, NY, 10021, USA
| | - Renaud LaFage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 350 E 70th St, New York City, NY, 10021, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California Davis Medical Center, 2315 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Chris Shaffrey
- Department of Neurosurgery, University of Virginia, 1215 Lee St, Charlottesville, VA, 22908, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, 1601 E 19th Ave #6250, Denver, CO, 80128, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, 350 E 70th St, New York City, NY, 10021, USA
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- International Spine Study Group Foundation, Littleton, CO, USA
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Horn SR, Shepard N, Vasquez-Montes D, Bortz CA, Segreto FA, De La Garza Ramos R, Goodwin CR, Passias PG. Chiari malformation clusters describe differing presence of concurrent anomalies based on Chiari type. J Clin Neurosci 2018; 58:165-171. [DOI: 10.1016/j.jocn.2018.06.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/24/2018] [Indexed: 11/29/2022]
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Horn SR, Passias PG, Hockley A, Lafage R, Lafage V, Hassanzadeh H, Horowitz JA, Bortz CA, Segreto FA, Brown AE, Smith JS, Sciubba DM, Mundis GM, Kelley MP, Daniels AH, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Hostin RA, Ames CP. Cost-utility of revisions for cervical deformity correction warrants minimization of reoperations. J Spine Surg 2018; 4:702-711. [PMID: 30714001 DOI: 10.21037/jss.2018.10.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cervical deformity (CD) surgery has become increasingly more common and complex, which has also led to reoperations for complications such as distal junctional kyphosis (DJK). Cost-utility analysis has yet to be used to analyze CD revision surgery in relation to the cost-utility of primary CD surgeries. The aim of this study was to determine the cost-utility of revision surgery for CD correction. Methods Retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, cervical sagittal vertical axis (cSVA) >4 cm, chin-brow vertical angle (CBVA) >25°. Quality-adjusted life year (QALY) were calculated by EuroQol Five-Dimensions questionnaire (EQ-5D) and Neck Disability Index (NDI) mapped to SF-6D index and utilized a 3% discount rate to account for residual decline to life expectancy (men: 76.9 years, women: 81.6 years). Medicare reimbursement at 30 days assigned costs for index procedures (9+ level posterior fusion, 4-8 level posterior fusion with anterior fusion, 2-3 level posterior fusion with anterior fusion, 4-8 level anterior fusion) and revision fusions (2-3 level, 4-8 level, or 9+ level posterior refusion). Cost per QALY gained was calculated. Results Eighty-nine CD patients were included (61.6 years, 65.2% female). CD correction for these patients involved a mean 7.7±3.7 levels fused, with 34% combined approach surgeries, 49% posterior-only and 17% anterior-only, 19.1% three-column osteotomy. Costs for index surgeries ranged from $20,001-55,205, with the average cost for this cohort of $44,318 and cost per QALY of $27,267. Eleven revision surgeries (mean levels fused 10.3) occurred up to 1-year, with an average cost of $41,510. Indications for revisions were DJK (5/11), neurologic impairment [4], infection [1], prominent/painful instrumentation [1]. Average QALYs gained was 1.62 per revision patient. Cost was $28,138 per QALY for reoperations. Conclusions CD revisions had a cost of $28,138 per QALY, in addition to the $27,267 per QALY for primary CD surgeries. For primary CD patients, CD surgery has the potential to be cost effective, with the caveats that a patient livelihood extends long enough to have the benefits and durability of the surgery is maintained. Efforts in research and surgical technique development should emphasize minimization of reoperation causes just as DJK that significantly affect cost utility of these surgeries to bring cost-utility to an acceptable range.
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Affiliation(s)
- Samantha R Horn
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Peter G Passias
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Aaron Hockley
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Hamid Hassanzadeh
- Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Jason A Horowitz
- Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Cole A Bortz
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Frank A Segreto
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Avery E Brown
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Daniel M Sciubba
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gregory M Mundis
- Department of Orthopaedic Surgery, Scripps Spine Center, La Jolla, California, USA
| | - Michael P Kelley
- Department of Orthopaedic Surgery, Washington University Orthopedics, Chesterfield, MO, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University Medical Center, Providence, Rhode Island, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Presbyterian/St. Luke's Medical Center, Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Christopher I Shaffrey
- Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Richard A Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, Texas, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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Diebo BG, Segreto FA, Jalai CM, Vasquez-Montes D, Bortz CA, Horn SR, Frangella NJ, Egers MI, Klineberg E, Lafage R, Lafage V, Schwab F, Passias PG. Baseline mental status predicts happy patients after operative or non-operative treatment of adult spinal deformity. J Spine Surg 2018; 4:687-695. [PMID: 30713999 DOI: 10.21037/jss.2018.09.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The study is a retrospective review of a multi-institutional database, aiming to determine predictors of non-depressed, satisfied adult spinal deformity (ASD) patients with good self-image at 2-year follow-up (2Y). ASD significantly impacts a patients' psychological status. Following treatment, little is known about predictors of satisfied patients with high self-image and mental status. Methods Inclusion: primary ASD pts >18 y/o with complete 2Y follow-up. Non-depressed [Short Form 36-mental component score (SF36-MCS) >42], satisfied patients (SRS22-satisfaction >3) with good self-image (SR22-self-image >3) at 2Y were isolated (happy). Happy and control patients were propensity-matched by baseline and 2Y leg pain, Charlson, frailty, and radiographic measures for the operative (OP) and non-operative cohorts (NOP). Health related quality of life (HRQL), surgical and radiographic metrics were compared. Regression models identified predictors of happy patients. Thresholds were calculated using area under the curve (AUC) and 95%CI. Results Of 480 patients, 94 OP (happy: 47 vs. control: 47) and 92 NOP (46 each) reached inclusion. At baseline, groups had similar age, gender, Oswestry disability index (ODI) (OP: 39.13 vs. 37.49, NOP: 17.70 vs. 19.74) and SF36-physical component score (PCS) (OP: 33.51 vs. 35.04, NOP: 47.93 vs. 44.72). Despite similar (P>0.05) surgeries, length of stay (LOS), and radiographic outcomes between OP happy and control groups, happy had less peri-operative complications (31.9% vs. 57.4%, P=0.13), better 2Y ODI (17.77 vs. 29.98), SRS22 component, total, and SF36 scores (P<0.05). NOP happy patients also exhibited better 2Y ODI (13.24 vs. 22.09), SRS22 component, total, and SF36 scores (P<0.05). Baseline SRS-mental (OR: 2.199, AUC: 0.617, cutoff: 2.5) and ODI improvement (OR: 1.055, AUC: 0.717, cutoff: >12) predicted happy OP patients, while baseline SRS-self-image (OR: 5.195, AUC: 0.740, cutoff: 3.5) and ODI improvement (OR: 1.087, AUC: 0.683, cutoff: >9) predicted happy NOP patients. Conclusions Baseline mental-status, self-image and ODI improvement significantly impact long-term happiness in ASD patients. Despite equivalent management and alignment outcomes, operative and non-operative happy patients had better 2Y disability scores. Management strategies aimed at improving baseline mental-status, perception-of-deformity, and maximizing ODI may optimize treatment outcomes.
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Affiliation(s)
- Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Frank A Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Nicholas J Frangella
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Max I Egers
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital-New York Spine Institute, New York, NY, USA
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Horn SR, Shepard N, Poorman GW, Bortz CA, Segreto FA, Janjua MB, Diebo BG, Vira S, Passias P. National Trends in the Prevalence, Treatment, and Associated Spinal Diagnoses Among Pediatric Spondylolysis Patients. Bull Hosp Jt Dis (2013) 2018; 76:246-251. [PMID: 31513509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Spondylolysis is an increasingly common diagnoses for young individuals and presents with a wide range of pathological and clinical findings. Most patients are treated conservatively, and surgery is reserved for severe cases. This is a populations study defining the incidence of spondylolysis in the Kids' Inpatient Database (KID) and assess trends in diagnoses, causes, and treatments. METHODS Retrospective analysis of the prospectively collected information in KID was performed for the years 2003 through 2012. Patients with a diagnosis of spondylolysis (ICD-9-CM 756.11) between the ages of 0 and 20 years in the KID were identified. Incidence of spondylolysis was established using KID-supplied hospital- and year-adjusted trend weights. Demographics including age, race, gender, and Charlson Comorbidity Index were assessed for all spondylolysis patients. Primary outcome measures were yearadjusted and hospital-adjusted incidence of spondylolysis. Secondary outcome measures were concurrent diagnoses and surgical details. RESULTS Six hundred and sixteen patients with a diagnosis of spondylolysis (329 with primary diagnosis) were identified (female: 53.8%; age: 15.27 ± 3.32 years). The incidence of spondylolysis is 7 per 100,000 patients nationally. Spondylolysis incidence has increased over time (p < 0.001) though the operative rate for spondylolysis has remained the same in the last decade (70% average, p = 0.52). The average CCI is 0.234, the average length of stay is 3.76 days and 92.4% of patients were discharged home. The etiology of the spondylolysis was trauma in 8.6% of patients (3.2% car crash, 1.9% pedestrian, 1.3% fall, 1.3% assault, 1.1% other transport, 1.0% sports, 0.3% motorcycle, 0.2% firearm, 0.2% bicycle; 1.9% reported multiple trauma etiologies). The most common concurrent diagnoses for all spondylolysis patients were spondylolisthesis (28%), idiopathic scoliosis (4.4%), cerebral palsy (1.9%), and spina bifida (1.8%). Four hundred and thirty patients with spondylolysis underwent surgical treatment and 40% of the surgically treated patients had spondylolisthesis. The rate of fusions was 54.9% fusions and 21% decompression, though the rate of fusions or decompressions being performed for spondylolysis has remained the same in the last decade (average fusion rate: 55%; average decompression rate: 18%; both p > 0.05). Levels fused and complications did not differ depending on whether or not decompression was performed (p > 0.05). The posterior-only approach was used in 62.2% of surgeries and were mostly 2 to 3 level procedures (63.5%). Perioperative complications occurred in 8.1% of patients, with the most common complications being device-related (2.3%), respiratory (1.5%), and digestive (1.5%). CONCLUSIONS The national incidence of spondylolysis has increased over time, and the surgical rate and treatment techniques have remained constant. The most common concurrent diagnoses were idiopathic scoliosis, cerebral palsy, and spina bifida. Further work is required to determine the significance of these trends and associations.
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